We mix our own: we pull up a vial of sodium bicarb and a vial of 2%
lidocaine on the first patient of the day. If there are 3 or 4 PICC nurses,
each nurse draws up their own. We draw up 4-5 mls of bicarb and add it to
the 20 ml lido vial. We then draw up 5 mls of buffered lido per patient
that we do. Each PICC nurse does 3-4 patients per day. We ALWAYS draw up
the buffered lido with a separate (new syringe and needle) and then draw
from that syringe on the edge of our sterile field.
The key is 1 vial per nurse, and that nurse always draws up the buffered
lido with a new separate syringe and needle and then draws from that syringe
fromthe edge of the sterile field.
You could have pharmacy mix it up for you, but we cannot predict our volume.
Some days we have as many as 20 PICCs on the schedule and we end up doing
at least 12 insertions. It depends on our sstaffing, and how easy or
difficult the insertions are.
We throw out the excess at the end of each day.
We also (all except one nurse) use L-Mx, 4% topical lido. We charge one
tube per patient. We slather it on the inner upper arm, apply tape, (I hot
pack everyone), and then set up my sterile field. We then wipe it off, and
wash the arm with Hibiclens surgical scrub, and then prep per usual (dry the
arm, alcohol, Chloraprep for 30 seconds). The L-Mx seems to dull that
initial needlestick wth the 25 g needle. I use the buffered lido very
superficially where I plan to put my needle, then deeper over the vein and
inject at least 1 - 2 mls over the vein depending on how deep it is.
The next trick is to wait. Count to 60 (seconds, don't count too fast) to
let the lido work. My patients tell me they feel a tiny prick and pressure
but hardly any pain.
Nadine Nakazawa
From: "Monahan, Maggie" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Date: Mon, 14 Aug 2006 12:39:32 -0400
For those of you who use buffered Lidocaine, who mixes the solution, and
how much Lidocaine and Bicarb are used? Do you obtain a vial for each PICC
line insertion? I use the Lidocaine in the Bard kit, but the "sting" seems
to be the greatest complaint I receive. I inject ~2-3cc of the Lidocaine
and inject in the area surrounding the vein. Most of my patients relate
that they do not feel anything after the initial "bee or wasp sting." Does
buffering the Lidocaine eliminate this problem, or just lessen it?
Maggie Monahan RN,MSN, CCRN
St. Francis Hospital
Columbus GA
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