Even though this information is correct, in practice, we have found for PICC
insertions, LMX4 does require more than 30 minutes to make sure that the
child doesn't feel any pain, regardless of the site of the PICC insertion at
the AC or above the AC with ultrasound. Have you found 30 minutes to be
effective time of contact with LMX? We might have to re-evaluate, if
someone is using it for less time and getting good results. Please let me
know.
Also, EMLA with the prilocaine seemed to cause more vasoconstriction, due to
the prilocaine, unless on longer than 1 1/2 hours. Not having to worry
about methhemoglobinemia reaction was also a consideration for our change.
Gwen
----- Original Message -----
From: "Pat Deisch" <[EMAIL PROTECTED]>
Cc: <[EMAIL PROTECTED]>
Sent: Thursday, May 11, 2006 9:18 AM
Subject: Re: LMX4 (elamax - like emla)
When I had researched L-M-X4 (Topical Lidocaine Cream) this is in brief
the differences that I found between L-M-X4 and EMLA Cream:
L-M-X4 is a 4% lidocaine cream provided with transparent dressing to
cover (Note: Has no prilocaine which EMLA Cream has, hence no
methemoglobinema reaction - sepaecially important for those infants and
neonates)
L-M-X4 takes only 15-30 minutes to be effective (EMLA cream tkes 60
minutes).
L-M-X4 is an over-the-counter medication - safe and non-invasive.
Pat Deisch MSN, RN
BryanLGH Medical Center
----- Original Message -----
From: "Gwen Irwin" <[EMAIL PROTECTED]>
Date: Wednesday, May 10, 2006 6:31 pm
Subject: Re: LMX4 (elamax - like emla)
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
