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Sample Protocol: Use of Buffered Lidocaine (Xylocaine) for Venipuncture

PURPOSE:
To provide patient with minute amount of local anesthetic at venipuncture site prior to initiation of peripherally placed intravenous catheters.

POLICY:
This policy and/or procedure reflects recommended guidelines for care. Clinical judgment is recognized as an integral part of individualized care and should be used when planning and providing the patient's care.

Registered nurses working in the Intravenous Therapy Department and IV certified nurses working in authorized areas may use buffered Xylocaine prior to initiation of venipuncture or accessing central venous ports. Note: in certain agencies a physician's order is not required.

All Intravenous Therapy nurses will carry multi-dose vial of buffered Xylocaine 1% without Epinephrine on IV basket to have available upon request from patient. When vial is mixed, the date is marked on label and all opened vials are to be discarded after seven (7) days.

PROCEDURE:
INTRAVENOUS THERAPIST OR OTHER REGISTERED NURSE AUTHORIZED TO PERFORM VENIPUNCTURE:

1. Inform patient of Xylocaine prior to venipuncture.
2. Verify that patient has no allergy to Xylocaine or other amide-type local anesthetics (prilocaine, mepivacaine, bupivacaine, etidocaine).
3. Prepare buffered Xylocaine using a 10:1 ratio of anesthetic to Sodium Bicarbonate. Add the appropriate amount of Sodium Bicarbonate to the anesthetic (i.e., 20 ml vial of Lidocaine 1%, add 2 ml of Sodium Bicarbonate).
   1. Put date and time on anesthetic vial and mark "buffered."
   If allergy to Xylocaine or derivatives exists, DO NOT USE; perform venipuncture without local anesthetic.
4. Withdraw 0.1-0.2 ml of buffered Xylocaine 1% without Epinephrine into a 0.5 cc insulin syringe with 28 or 30 gauge needle attached.
5. Explain procedure to patient.
6. Cleanse wide area with iodophor prep in a circular motion for a minimum of 30-second contact.
   Alcohol may be used if patient has an allergy to iodine.
7. Insert needle with bevel up intradermally approximately 1/2 cm below or to the side of the proposed entry site of intravenous catheter.
   1. Aspirate plunger of syringe to verify that vein has not been entered.
      Do not inject Xylocaine into blood stream. If blood return is confirmed, remove syringe and needle and perform a second intradermal injection.
   2. Inject 0.1-0.2 ml buffered Xylocaine 1% without Epinephrine intradermally, creating a small wheal.
8. Perform venipuncture with intravenous catheter entering skin within the wheal of Xylocaine.
9. Document venipuncture with use of buffered Xylocaine 1% without Epinephrine in patient's chart.

References

1. Wong DL, Pasero CL: Using local anesthetics to control procedural pain, Am J Nurs 97(1): 17, 1997.
2. Wong DL, Pasero CL: Reducing the pain of lidocaine, AJN 97(1): 17-18, 1997.

Additional Information

• Beyond First Do No Harm: Principles of Atraumatic Care

March 15, 2002

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