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Standard of Care (Lidocaine administration) for Modified Seldinger Technique

We have been using an injectable wheal of lidocaine 1% with and without bicarb prior to our needle stick and then again before our skin nick.  This practice is being examined by nursing administration.  They are asking for the standard of practice for this injection of an anesthetic agent.  Can anyone lead me in the right direction or provide help with this.


I know the INS statement regarding least invasive and I have explained that a topical anesthetic wouldn't be very practical in this situation.

Infusion Nursing Standards

Infusion Nursing Standards of Practice #40 Local Anesthesia, page S41

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

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

Lynn, I provided this to


I provided this to them, however, they are focused on least invasive first.  I can't believe that a topical agent would be effective nor practical.  There are times when gaining access is not achieved where one initially thought they were going to go or even having to switch to the opposite site.  We cannot wait nor make our patient's wait for a topical to start working if the first attempt is not successful.

Do others use anesthetic agents successfully without injecting intradermally?

Angela Lee
We use LMX4 and it is very

We use LMX4 and it is very effective but does take at least 30 minutes to work and many times we will leave it on longer.  We also apply it to two sites to give us a backup plan if necessary.  We do not MST everyone but when we do we will use Lidocaine 1% in addition to the LMX4. 

This is in pediatrics where needle sticks may be more of  an issue to the patient.  But you are correct--it is not always practical.

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