I had a colonoscopy (my 3rd) yesterday, in a location and with staff that were new to me, and not only did they get the IV in on the first try (I’m a difficult subject so that was a nice thing) the nurse used lidocaine on the area before the stick so that it wouldn’t hurt. She even asked “if that is okay.”
That’s the first time, as far as I am aware, that anyone has used lidocaine on me for a venous needle stick for either drawing blood or setting an IV. I didn’t even know that was an option. In skilled hands a venous needle stick (sorry if that isn’t the right technical term) hurts a little but I haven’t minded it. I have, though, had any number of unskilled hands at work, who have had to dig around to find a vein, and that does hurt, sometimes not a little. For my first colonoscopy they had to stick me more than half a dozen times before they got it in.
Has this (using lidocaine) been a common thing for other people? Is there any reason this wouldn’t be standard practice? Can I ask for lidocaine if they don’t volunteer it?
The product I’m acquainted with is a combination of lidocaine and prilocaine.
The use of EMLA Cream to numb an area before a needle stick has been around a long time. As I understand it, it is used more often in pediatrics. There are pros and cons. EMLA cream takes up to an hour to have an effect. People who use large amounts frequently (often done with “esthetic” surgery) can experience heart palpitations and even death.
People have tried using EMLA prior to a tattoo, but the tattoo artists I know will not use it, as it changes the “texture” of their canvas.
Interesting. She called it “lidocaine,” possibly as a convenient shortening of the ingredients list. It was apparently a liquid which required, again apparently, only a few seconds to take effect.
I don’t know if it’s Lidocaine but my dentist always uses a topical anaesthetic before injecting the local, that makes the process much less unpleasant
I’m unfamiliar with a fast acting liquid, but would love to know more. I’ve used EMLA, but not often because of time it takes. We use L.E.T. (lidocaine, epinephrine, tetracaine) frequently in the ED but that’s for wounds, it’s not well absorbed through intact skin.
Also, I just wanted to say that you can have very skilled hands and, sometimes, still induce a lot of pain. You never know what’s under the skin.
I expect that’s probably true. What I have had more than once is a phlebotomist who takes me as a challenge, when I am having blood drawn for lab work. “I have difficult veins, they usually take it from my hand” followed by the phlebotomist, who knows better than any patient, digging around in my elbow for a while before giving up and going for the hand. One of them still couldn’t find a vein and had to ask for someone else to do it. I used to be patient about that kind of thing, but not any more.
Never heard of this. I donate blood as rapidly as the recovery allows and have had numerous venous sticks for other reasons including IVs and sampling. I’ve also had a few arterial sticks as a pulmonary patient. It doesn’t seem worth it – they just don’t hurt enough to fix.
Now, for pediatric patients, it sounds like a great idea. Squirming kiddies could significantly impede their own care, right?
In pediatrics we use Pain Ease, a topical aerosol spray that “freezes” the skin almost instantly. It works great as long as the patient doesn’t mind the insta-freeze (some do).
Because cold constricts blood vessels, I’ve wondered if using the spray makes the poke even more difficult. I’ve been told that the chill does not penetrate deep enough for that to matter, though.
EMLA cream is reserved for difficult draws only due to delay of onset (half hour to an hour) and expense.
Neither one is indicated for routine blood draws or IV starts.
I do the platelet donations every couple of weeks, requiring at least two sticks, the draw and the return. I’m at the age where my veins, although prominent, will tend to roll, which usually causes problems on the return line. Usually after three misses they’ll call in Erica. There’s a vein in the top of my forearm, around three fingers above the wrist. Erica always warns me, “It’s going to be a big pinch!” and then she sets the needle with authority. She’s right about the big pinch, it’s a painful stick, but it’s one and done. I’m sometimes tempted to ask for Erica right out of the box, because three easy sticks and a painful one is worse than just the painful one, but sometimes the first stick works, so I let them try the antecubital first. They’ll usually try twice there and then once in the back of the hand before going to the bullpen for their closer.