Re: LMX4 (elamax - like emla)

[Gwen Irwin]

We use LMX4 (latest name for Elamax) all the time on pediatric patients and do MST with the scalpel for the nick.  For PICC insertions, we also leave it on as long as 1 1/2 - 2 hours.  (For PIVs, less time.)  With the large barrier drape in place, the children do not react at all to the stick or the scalpel.  We have had babies sleep through their PICC insertions.  We have had children verbalize nervousness about feeling anything, after we are completely done and waiting for x-ray.  So, it works well. On the adult side of our PICC insertions, we don't have time to wait for the LMX4 to work, so we use intradermal bacteriostatic NS.  In rare cases, we will then also use intradermal lidocaine (very high anxiety patient that has had a lot of pain with IV attempts-just a gut feeling about which patients to use lidocaine also).  The patients are very happy about their pain free PICC insertion. Gwen Irwin   ----- Original Message ----- From: Susan Fullana To: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Wednesday, May 10, 2006 5:30 PM Subject: elamax (like emla) We use elamax on adults and in the past a few pedi patients. I have used it for introducer placement and mst. If you leave it on for a long period (I like 1-1 1/2 hours myself) I find it works great. However, when I place with mst, I DO NOT use the scalpel. I use the microintroducer-I take it apart and use the inside first--- in and out a few times then, I put it back together and place the entire introducer in. Pts seem to tolerate this well. Would not even think of trying to use a scalpel with just elamax. Currently only myself and one other nurse (she has just started mst) are using mst to place PICCs. We are trying to get an ultrasound machine and a new position for u/s PICC placement. I worked per diem in another hospital where PICCs were only placed using MST and ultrasound and we always used lidocaine only---never elamax. Hope this helps. Susan J. Fullana