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nina ainslie
Lidocaine order for peripheral IV starts

Our hospital  currently requires a physician order for using lidocaine with peripheral IV starts in the inpatient units.We would like to know how many of you must have a physician order for lidocaine usage. Or do you use lidocaine without an order?  Do you have established protocols or policies to support this?  I would like to hear from both sides.

In the past, I have written
In the past, I have written policies and procedures that allowed for the use of intradermal lidocaine based on nursing assessment only. These p&p's went through the internal review process and were accepted without requiring an individual physician order for each patient. I am assuming that you are referring to an intradermal injection of lidocaine. There are several other technologies that do not require an intradermal injection though. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Would you please send me a
Would you please send me a copy of this policy?
Gwen Irwin
We do have a policy for

We do have a policy for local anesthesia for IV insertions.  It is for topical anesthesia (our institution uses LMX4) or for intradermal lidocaine 0.1 ml.  Since this was approved by our Pharmacy and Therapeutics (physician) Committee, the nurse does not have to have an individual order for using it on the patient.

We do have a large percentage of nurses that still think they have to have an order.  We are still educating them and hoping to decrease the patients' complaints of pain with IV starts.

 Gwen Irwin

Austin, Texas

Kathy Hartman
At our facility of Med Exec.

At our facility of Med Exec. comm. has approved a standing protocol that intradermal lidocaine can be used by nursing for IV starts. Which has eliminated the need for individual orders. 

 Kathleen Hartman, RN BSN

Kathleen Hartman, RN BSN

Our facility has lidocaine

Our facility has lidocaine as part of our p&p for starting IV's.  No MD order required, but most nurses don't use it--working on educating and modeling-the Vascular Access nurses use it and the pt. is always so relieved and then, also confused, as to why the other nurses didn't use it also.

Would you be willing to
Would you be willing to share this policy? Thanks. Please e-mail privately [email protected]

Cindy Hunchusky, BSN, RN, CRNI

Pam Michael
How many facilities use
How many facilities use lidocaine intradermal for IV starts? I have been an IV nurse for 12 years and never used lidocaine for IV starts, for PICC insertions yes but only for the nick in skin with MST. Pam

Pam Michael, RN

At our facility, we have had

At our facility, we have had a policy for at least 15 years that we may use buffered 1% Lidocaine (buffered by pharmacy)intradermal for peripheral starts.  All the I.V. nurses

and every nurse we taught were using it regularly.  Now we have switched our

policy to say that the first choice for local anesthetic for peripheral I.V. starts is

bacteriostatic normal saline intradermally(the benzyl alcohol in the solution is what

causes the numbing).  there have been several studies on the efficacy of bact.

normal saline as a local anesthetic...I don't have them at hand.  It works as well

for us as the Lidocaine.  Patients are so thankful when we use a local and as

someone else said, they ask, "why don't all the nurses use it?"

  The nurses who don't use it give one of two excuses:  "It's 2 sticks instead of 1"

or "It hides the vein...or makes it disappear".   Our answers:  "I'd rather have

two sticks when the first one is intradermal with a 30g needle...and I don't feel

the second stick with the much larger needle"   and   "there is a small, short

learning curve until you can realize that the vein is still there, even if you can't

see it right where you're sticking...and it doesn't make the vein disappear if it

is injected just intradermally so it doesn't touch the vein wall" 

  Use of a local makes such a difference to the advice is to start using

it if possible.

T. Nauman RN, CRNI

Has anyone used that new jet

Has anyone used that new jet syringe at AVA that numbs the site with lidocaine before peripheral IV's

I know that they are using this device in Fort Wayne Indiana so if anyone from Fort Wayne can comment on its usaage or Elkhart Indiiana

Kathy Kokotis

Bard Access Systems

Vicky Grillo
I've heard of it & have some
I've heard of it & have some information but the pharmacist where I work has been unsuccessful in contacting the company.
I am interested any research

I am interested any research that compares the use of lidocaine vs. bacteriostatic normal saline (or even one anesthesiologist stated he preferred bacteriostatic water for injection) for not only peripheral IV starts, but also for PICC insertions.  I had a patient the other day allergic to Lidocaine and was hesitant to stick and nic the skin for the introducer without any anesthetic what-so-ever.  Can anyone out there site specific studies?



Michelle Todd CRNI
Oncology Nursing Forum •
Oncology Nursing Forum • Vol. 36, No. 4, July 2009 E199
effects of intradermal injection of normal saline with benzyl alcohol or lidocaine in 40, 47, and 221 preoperative adults, respectively. Other researchers investigated alter­native methods of analgesia for IV insertions, including topical skin coolants (Hartstein & Barry, 2008), a topical local anesthetic cream

Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]

For Trish and the group:

 "Comparison of Bacteriostatic Normal Saline and Lidocaine Used as Intradermal Anesthesia for the Placement of Intravenous Lines"

Journal of PeriAnesthesia Nursing, Vol 21, No 4 (August) 2006 pp 251-258.


David Bruce RN

Tanya, Wondering if you


Wondering if you could put your hands on the studies you referred to in your earlier comment and share with me?  I tried posting a general request, but have received no responses thus far.

If so, please email to [email protected]



Alma Kooistra
Nina....... I have some


I have some resourses which address this issue in my file at the office.  Please give me a fax number and I'll send to you.  This forum has been removed from acceptable web sites for viewing at my office, so I'd ask you to email me with your fax number at [email protected] 

Alma Kooistra RN CRNI


Wondering if a doctors order

Wondering if a doctors order is needed for bacterialstatic normal saline for IV start?



That depends on the

That depends on the decision-makers in your hospital. It could be written into protocol and not require a doctors order. So I would check with your facility risk manager, P&P committee, etc. for a decision for your facility. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Jonathan Rolt
buffered lidocaine for IV starts

Does anyone have studies for this and other info related to it. My D.O.N. is interested in changing the policy to include this.

It really depends on more

It really depends on more than the decision makers in your hospital.  It also depends on your State Board of Nursing.  I recently went through an extensive ordeal over this issue.  We had a physician endorsed protocol for topical and injectable anesthetics where the RN (after patient assessment) could administer the most appropriate anesthetic.

In NYS the only medications that can be administered 'per protocol'/without a patient specific order is Tb test, HIV skin test, and medications for anaphylaxis.

So, if an anesthetic is necessary, then that specific patient must have an order for it.  It cannot be a population specific order.  To comply with this we have linked the anesthetics with the peripheral IV insertion order and a physician can remove them or leave them in place.  If they are left in place then the anesthetics (Lmax cream, 1% lidocaine, BSNS) will appear on the patient's MAR.

Angela Lee
I am having the same problem

I am having the same problem at my facility.  I have tried to get LMX4 as a standardized order for years.  I have been told that that would be equivalent to the nurse "prescribing" and we have to have an individual order for every patient.   Now I am asking physicians to make it a part of their admission orders for every patient just as they do diet and activity.

Angela Lee, BSN, CRNI

Children's health Systems

Birmingham, AL 35235

It is included in our policy

It is included in our policy so that we can order it and select "per protocol" in our electronic order system. It is ordered under the physicians name.

We have a protocol for

We have a protocol for 1%buffered lidocaine with PIV, but as other comments, many nurses don't use it because they are unaware of the policy, or choose not to use it (2 sticks vs one and loss of vein issues.)  I use it often, and have found it to work quite well and is a patient satisfier.

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