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Mats Stromberg
Numbing the MST stick?

Dear listers,

first time trying to start a topic on this version of the list. Exciting!

My question: Do you use any local anaesthetic before the initial punktion of the vein using MST. Lidocain, cold, something else? We use lidocain before the skin nick, but nothing before that and sometimes the first stick is quite painful to the patient, even if you do not hit a nerv.

Thanks

Mats in Stockholm

Gwen Irwin
We use a lidocaine bleb at

We use a lidocaine bleb at the insertion site, before the initial venipuncture.  We usually use enough that additional is not needed before the nick of the skin.

Gwen Irwin

Austin, Texas

Mats Stromberg
How deep do you inject the

How deep do you inject the lidocain? How much?

Does it affect what you can see on the ultrasound screen, i.e. is it more difficult to see the vein after lidocain? I mean, it's a fluid and US sees fluid, right?

 

Mats

Timothy Royer B...
Lidocaine is always injected

Lidocaine is always injected intradermal.  Initially 1-2mls.

I actually keep the ultrasound on when I inject so I can see if the Lidocaine is going where I want it to.  The fluid nevers obscures the vein.  Also of note, of all the PICCs that I have placed and injected the Lidocaine intradermal the vein never shrinks.  I have seen others that if subq veins have shrunk.  Don't know if that is the effect of the Lidocaine or from the Lidocaine fluid pouch pushing down on the vein.

Tim

We use buffered !% Lidocaine

We use buffered !% Lidocaine intradermally and subcutaneously, using the Ultrasound

to see where the Lidocaine is going.  We have no problem with the vein shrinking

as long as we don't let the Lido touch the vein wall.  Often we use more Lido

for the skin nick(though we don't always need to do a skin nick.)

T. Nauman RN, CRNI

Susan S
I use plenty of Lidocaine,

I use plenty of Lidocaine, most people do not like needles. Our routine is to use buffered Lidocaine before the venipuncture AND the dermatotomy (skin nick).  We buffer Lidocaine by drawing up about 1 ml of Bicarb (we use 1%) before the 5 ml of 1% lidocaine.  I want to leave the patient with LESS fear of needles than before the procedure.  We hardly ever get complaints of painful insertions.

   One thing to be aware of tho, I have seen the lidocaine make those veins get substantially smaller if they are very superficial veins (even in the upper arm on some itty bitty people)..so be careful to make the lidocaine sub dermal and not subcutaneous.

Susan Schuetrumpf, RN, CRNI, VA-BC
Atlanta GA

jearls01
buffered lildocaine

do you have and evidence base to back this practice?

Mats Stromberg
So how close to the vein

So how close to the vein would it be OK to inject the lidocain (without affecting the view or size of the vein) ?

Or is the trick to distinguish intradermal from subq? How could I do that using the ultrasound?

Any risks associated with the method (apart from allergy to lidocain)?

Mats

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