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Local Anesthetic For Starting Peripheral IVs (PIVs)

I wanted to expand on a previous post regarding the placement of peripheral intravenous (PIV) catheters. Some use a small wheal of local anesthetic to minimize discomfort associated with the IV needle placement in awake patients… especially for large IVs.

Place enough subcutaneous wheals of lidocaine, and you’ll hear patients report burning/pain just from the anesthetic. This can often be blunted by adding bicarbonate to the solution, but in practice, this is rarely done for simple local infiltrations. So what’s more painful – the local anesthetic or the needle? Some argue that small IV needles (22G, 24G) hurt less than the anesthetic itself, and therefore, lidocaine is rarely used in these instances. I used to fall in this school of thought.

I’m now beginning to realize that pain related to the indwelling catheter is often a real nuisance to patients (even from a “small 20G”). At least some local anesthetic infiltration would provide numbness in the associated area for several hours?

Drop me a comment with your thoughts and habits!


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