3/28/2014 1 Lining Up to Infuse Excellence Local Anesthesia in Infusion Local Anesthesia in Infusion Local Anesthesia in Infusion Local Anesthesia in Infusion Therapy Therapy Therapy Therapy Sandra Drozdz Burke, PhD, RN, APN, BC Clinical Associate Professor University of Illinois at Chicago, Urbana Campus Lining Up to Infuse Excellence Disclosures • Speaker’s Bureau: Janssen Pharmaceuticals Lining Up to Infuse Excellence Question #1 Question #1 Question #1 Question #1 • How often do you use/apply a pre-anesthetic prior to starting an IV? A. Always B. Sometimes C. Rarely D. Never
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3/28/2014
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Lining Up to Infuse Excellence
Local Anesthesia in Infusion Local Anesthesia in Infusion Local Anesthesia in Infusion Local Anesthesia in Infusion
TherapyTherapyTherapyTherapy
Sandra Drozdz Burke, PhD, RN, APN, BC
Clinical Associate Professor
University of Illinois at Chicago, Urbana Campus
Lining Up to Infuse Excellence
Disclosures
• Speaker’s Bureau: Janssen Pharmaceuticals
Lining Up to Infuse Excellence
Question #1Question #1Question #1Question #1
• How often do you use/apply a pre-anesthetic prior to starting
an IV?
A. Always
B. Sometimes
C. Rarely
D. Never
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Lining Up to Infuse Excellence
Question #2Question #2Question #2Question #2
When using local anesthetic for adults, are you more inclined to
use:
A. Intradermal lidocaine (unbuffered)
B. Intradermal Buffered lidocaine
C. Intradermal Bacteriostatic Saline
D. Topical lidocaine cream or patch
E. Other
Lining Up to Infuse Excellence
Question #3Question #3Question #3Question #3
When using local anesthetic for children, are you more inclined
to use:
A. Intradermal lidocaine (unbuffered or buffered)
B. E.M.L.A.
C. LMX4
D. Iontophoresis
E. Other
Lining Up to Infuse Excellence
Session Abstract
Local anesthesia is an important component in infusion therapy,
helping to decrease pain and anxiety of patients during
peripheral intravenous access. While saline and lidocaine are
the most commonly used products, other products have been
developed for various infusion settings. Proper administration of
local anesthetic agents, as well as selection of the most
appropriate agent, promotes successful peripheral
venipuncture.
This session will discuss the pharmacokinetics of local
anesthetics, side effects and contraindications for use, and best
practice administration techniques.
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Lining Up to Infuse Excellence
“
”
It is easier to find men who will
volunteer to die, than to find
those who are willing to endure
pain with patience.
Julius Caesar
As nurses, we have the opportunity to create a patient-care
environment where pain is minimized – or eliminated
completely. Why would we choose not to do that?
Lining Up to Infuse Excellence
Learning Objectives
1. Identify the pharmacokinetics of
the available local anesthetic
agents.
2. Describe administration
techniques that improve
efficacy or comfort in local
anesthesia delivery.
Lining Up to Infuse Excellence
EVIDENCE SUPPORTING PRACTICEEVIDENCE SUPPORTING PRACTICEEVIDENCE SUPPORTING PRACTICEEVIDENCE SUPPORTING PRACTICE
Most recent
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Literature review
• Cochrane database of
systematic reviews (CDSR)
• National guidelines
clearinghouse
• CINAHL
• PUBMED/MedLine
• Key words
– Venipuncture and Pain
• Local anesthesia/anesthetic
• Topical
anesthesia/anesthetic
• Limits
– English
– Research/evidence
– 2000 – 2014
– Adults (search #1)
– Children (search #2)
Lining Up to Infuse Excellence
Cochrane Systematic
Reviews
• Psychological interventions for needle-related procedural pain and
distress in children and adolescents (2013 Review)
• Topical anaesthesia for needle-related pain in newborn infants (2013
Protocol)
• Adjusting the pH of lidocaine for reducing pain on injection (2010
Review)
• EMLA and Amethocaine for reduction of children’s pain associated with
needle insertion (2006 Review)
http://www.cochrane.org/cochrane-reviews
Lining Up to Infuse Excellence
Practice Guidelines
• National Guidelines clearinghouse
– Search
• IV therapy
• Local anesthesia for VIT = 0
• Local anesthesia for intravenous therapy = 0
• Topical anesthesia = 47
– None relevant
• Local anesthesia – limited to venipuncture
– 1 relevant (submitted by ENA)
• Infusion Nurse Society SOP
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EBP Process
Keyword Search1988 – 2014
N= 291
Included: research and review articles r/t topical or local anesthesia prior