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Peds PIV start pain control strategies

What strategies have been helpful to you.  Our ED wants to use a ethyl chloride coolant spray which is not sterile and flammable, and I would like to offer an alternative. Thanks Kathy Brown

There are numerous

There are numerous alterantives including transdermal patches like Synera, pressure accelerated lidocaine, low pressure ultrasonification, and iontopheresis to name a few. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Jenn M.
We use J-tip a large

We use J-tip a large percentage of the time.  We also have access to emla, Synera, and for the babies we use Sweet-ease.

What is J-tip? Lynn

What is J-tip? Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

J-tip is actually the

J-tip is actually the delivery device, which is a needleless jet injector powered by carbon dioxide (similar to Zingo except Zingo was powered by helium)- here is a link for the device  You then have to fill the device with the lidocaine, which most outsource to specialty pharmacies- these devices were actually developed to administer hormones and insulin and they have transitioned over to pain prevention in the last decade or so.  There are several studies on J-tip and I have listed a few below- I did an extensive EBP review of lidocaine delivered by needleless jet injector in pediatrics, which included J-tip several months ago while in school.  We hope to trial the product here very soon.

Jimenez, N., Bradford, H., Seidel, K. D., Sousa, M., & Lynn, A. M. (2006). A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient. Anesthesia and Analgesia, 102(2), 411-414. doi:10.1213/01.ane.0000194293.10549.62

Auerbach, M., Tunik, M., & Mojica, M. (2009). A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16(5), 388-393. doi:10.1111/j.1553-2712.2009.00401.x

Pershad, J., Steinberg, S. C., & Waters, T. M. (2008). Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 162(10), 952-961. doi:10.1001/archpedi.162.10.952

Spanos, S., Booth, R., Koenig, H., Sikes, K., Gracely, E., & Kim, I. K. (2008). Jet injection of 1% buffered lidocaine versus topical ELA-max for anesthesia before peripheral intravenous catheterization in children: A randomized controlled trial. Pediatric Emergency Care, 24(8), 511-515. doi:10.1097/PEC.0b013e31816a8d5b




The J-TIP is a single use, self-contained needle free jet injector.
It was designed for insulin administration, but mentions that it can be used with other medications as well. 
The J-TIP uses high pressure to push medication into the subcutaneous tissue.

Here is a link to a PDF of an article published in 2008 in Pediatrics (Journal of American Academy of Pediatrics).
Pharmacologic Approaches for Reducing Venous Access Pain in Children.
This article discusses the use of methods such as the J-TIP, intradermal injection, topical creams (EMLA and others), iontophoresis, laser or ultrasound assisted anesthetic delivery, and vapocoolant sprays (ethyl chloride).

/Tess Hopkins

Robbin George
So the clinician loads the

So the clinician loads the syringe with Lidocaine?--How long prior to insertion of a catheter?--How much Lidocaine?--Can this be used for PORT access?

Thank you in advance of your answer

Robbin George RN VA-BC

J tip

I have used a j-tip (pre-filled with buffered lidocaine) prior to inserting a PICC in children as well as for IV starts.  The only thing is that it does make a popping noise which is similar to holding a soda can near one's ear....and that the child needs to be prepared for the noise.  It is also best to deliver it via z-track method; not directly over the vein. 

Our doses are pre-filled and sent to the units per pharmacy order.  The j-tip has revolutionized IV starts for kids.  It's also great for piccs as it can be applied prior to draping the arm and remains effective for well over 30 minutes. It should be used carefully for heme/onc patients as it can cause petichae/bleeding at the site. It should NOT be used for port accessing.


We are ready to trial the j-tip but hear good things about it. I don't like the ethyl chloride because it doesn't last long enough for the procedure most of the time.  Is Synera used in pediatrics as well?  Theresa Reed

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