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buffered lidocaine
Finally got my preprinted orders for PICC done and now pharmacy is balking at using buffered lidocaine.  I had a lit search done and only have one reference which was a study of perceived pain. I think standards of use would help towards convincing. If anyone can comment or direct me where to get ammo, I would be appreciative. thnx
Vicky Grillo
Would you share the formula

Would you share the formula with me? Our pain team is attempting to institute preemptive analgesia for IV insertions throughout the hospital. Currently, it's only available to pt's in same day surgery (intradermal lidocaine).


The formula is 1ml of sodium

The formula is 1ml of sodium bicarbonate(1 mEq /ml) mixed in 10 ml of 1% lidocaine without epinephrine. This results in a sodium bicarbonate concentration of 0.09 mEq/ml in  1%  lidocaine hydrochloride. The dose you use is up to you. I did a study with my colleague Dana Aholt RN, which was published in the Journal of Infusion Nursing , Nov/Dec 2001. " Local Anesthesia Prior to the Insertion of Peripherally Inserted Central Catheters". We compared using buffered lidocaine, EMLA cream, and no anesthesia. The dose of buffered lidocaine used was .2 ml of the solution, which works  well.

    Buffered lidocaine works very well. there is virtually no pain except the sting of the intradermal needle. The patients liked it very much.  You can mix it yourself if you like. It is stable at room temp for one week. the pharmacist mixed it for our study because it had to be recorded in a log book for the FDA because it was for a study.

                Thank you. Cheryl Fry CRNI

anna liang
How do we decide how much
How do we decide how much lido to use & how many minutes to wait for the lido be effective?

I use ultrasound 100% and about half of the piccs are done with sedation.
one sedation MD insists that I should use at least 2-3 ml & wait about 15 min for the lido to penetrate to vein
For many years, we used

For many years, we used plain 1% Lidocaine for PICC insertions and many of the patients complained a lot about the pain of injection...we watched it cause vasoconstriction at times(saw it occur as we watched with the ultrasound).  We

then started having 5 ml of 1% Lidocaine(w/o epi)and a vial of "Neut"(sodium bicarb)

put on our PICC trays. We mix 5ml of Lido and 1/2ml of Neut for local injection.

We use "as much as it takes", usually 1-2 ml.  I personally, while watching with ultrasound, insert

the needle until it is close to the vein, then start injecting as I pull out.  This injects

the area near the vein, the subq in the path of the proposed needle insertion, and the

skin where the stick will be made.  I'm not necessarily suggesting that anyone else

do it this way, but it has worked well for my practice.  In my experience, the anesthetizing effect is practically immediate.  We don't wait any prescribed amount

of time.

  As to the use of local for peripheral I.V. starts, we've used plain 1% Lido, buffered

Lido...but we now use bacteriostatic saline and have found it to work very well, plus

it is cheaper, less painful for the patient, and much more convenient for the nurses.

I can give reference articles for anyone who wants them .  I even used it successfully

for PICC placement a couple of times when the Lido ampul in the kit was broken.


T. Nauman RN, CRNI

Vicky Grillo
Tanya,  Would you please


Would you please send me your references for the bacteriostatic saline. I found 3... Minogue & Sun Anesth Analg 2005, Brown J Inf Nurs 2004, and Windle J PeriAnes Nurs 2006. Do you have others?

Would you possibly share your policy with me and/or provide information on implementation of this practice hospital wide? Do you have a competency test?

I'm new to this list-serve. My backround is pain management nursing

Thanks so much,


[email protected]

Tanya, Could you please


Could you please email the reference articles you mentioned to me at [email protected] ?  Thanks so much.

Wanda Balerud
Tanya,  Can you please


 Can you please email me the references that you have regarding the Lidocaine with Bacteriostatic Sodium Chloride to [email protected]

Thank you,



Pam Michael
Tanya, Would you email your


Would you email your reference articles to me as well.



[email protected]

Pam Michael, RN

buffered lidocaine

could you please share with me also the evidence based research on this topic. there does not seem to be much out there. i just read an article in Outpatient Surgery Magazine that talks about the buffered lidocaine but had no references. Thanks

Tanya, Would you email those


Would you email those references you spoke of to me @ [email protected]



Tanya, Could you please

Tanya, Could you please email the reference articles you mentioned to me at [email protected].  Currently we use 1% lido that comes in the PICC trays for PICCs and nothing for peripherals unless requested.  And then we use 1%lido.  Would love to start using the  bacteriostatic saline if it works that well.

Thanks in advance,


Anne Marie Frey
here are some references for

here are some references for buffered lidocaine and saline with preservative.                                                                                                   Anne Marie Frey RN, BSN, CRNI

Clinical Nurse Level Four

Vascular Access Service: I.V. Team

The Children's Hospital of Philadelphia

Anne Marie Frey RN, BSN, CRNI, VA-BC
Clinical Expert
Vascular Access Service: I.V. Team
The Children's Hospital of Philadelphia
[email protected]

Wanda Balerud
Thank you very much for the

Thank you very much for the references Anne Marie.  I appreciate it.



Gina Ward
Timing of lidocain injection


When are you injecting your local?  We usually cannulate the vessell and then when it is just the guidewire in place inject with local prior to the skin nick and introducer being placed.  We were also trained to make just a "bleb/wheal" with the local.  I think this would only do any anesthetic effect for the skin nick and not the painful passage of the introducer right??

 It sounds like some inject with local prior to cannulating the vessel itself.  If you are doing the injecting prior to cannulating the vessell , how can you be sure the route or area of infiltration will be the same the needle guide will direct your needle insertion since it goes at such an angle. (local  would be free hand and other us/needle guided)

It sounds great to infiltrate in advance , but then you may end up with several infiltration sites if unsuccessful with first vessel selected.

Thanks in advance for any response,  Gina Ward R.N. CPAN

Gina Ward R.N., VA-BC

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