Utilizing lidocaine: Increasing awareness to decrease the pain experience
Sauer, Nicole M.
This project was established to increase awareness among nursing students about a technique they can use to decrease the pain their clients experience with insertion of peripheral intravenous catheters. After collaborating with a registered nurse IV therapist to discuss information about lidocaine, proper utilization and how patients benefit from its use, an instructional video was developed. While the Infusion Nurse Society recommends using the least invasive methods first (i.e. topical lidocaine cream), I have chosen to develop a video demonstrating the use of injected buffered lidocaine because the technique required is more advanced than applying a cream to the skin. Level III nursing students enrolled in NU473 Nursing III are viewing the video and completing a short survey regarding their thoughts on the video; results are currently pending. Initially this project will impact the students following me in the nursing program by increasing their knowledge and skill base. On a grander scale, it will impact the patients these future nurses care for by decreasing the pain they experience with peripheral IV insertion.
UTILIZING LIDOCAINE: INCREASING AWARENESS AND DECREASING THE PAIN EXPERIENCE STUDENT: NICOLE SAUER FACULTY MENTOR: JANE ROBINSON WASHBURN UNIVERSITY, SCHOOL OF NURSING Special Thanks: Jane Robinson Debbie Isaacson Eric Johnson Nick Brown Jenny Boswell Libby Smith Pat Parker Lawrence Memorial Hospital, Department of Pharmacy and IV Therapy Cari Meats Washburn Nursing Students Results Purpose •Develop an instructional video presentation on the use of lidocaine for peripheral IV insertion •Discuss lidocaine in terms of what it is, why it is used •Discuss advantages and disadvantages of using lidocaine •Increase personal knowledge •Increase awareness of a simple pain relief measure among future nurses by including the video as a supplemental resource in NU440 Nursing Technologies III—when IV skills are learned Conceptual Framework Katherine Kolcaba’s Theory of Comfort includes several assumptions: •comfort is a desirable, holistic outcome that is at the heart of nursing •human beings actively strive to meet their comfort needs •enhanced comfort leads to an increase in health seeking behaviors resulting in empowerment, leading to satisfaction with health care •institutional integrity is strengthened when the organizational value system is oriented toward the recipients of care Methods For the filming portion, participants included a registered nurse, narrator, volunteer actor (to play the role of patient), and a videographer. All parties being recorded signed audio/video recoding release forms. The actor signed a consent form for placement of an IV using lidocaine by a registered nurse. For the survey portion, all participants were Level III nursing students, enrolled in NU473 Nursing III. Participants were invited to view the video and complete a short electronic survey via an announcement made by the principle investigator in class. After signing a consent form, 45 interested parties were e-mailed a link for viewing the video and completing the survey. Of the 45 who received the link, 15 completed the survey. References Dowd, T. (2006). Katherine Kolcaba: Theory of comfort. In Tomey, A. M. & Alligood, M. R. (Eds.), Nursing theorists and their work (pp. 726-740). St. Louis: Mosby. Infusion Nurses Society. (2006). Infusion Nursing Standards of Practice. [Supplemental Material] Journal of Infusion Nursing, 29 (1 Supplement), S41. Infusion Nurses Society. (2011). Infusion Nursing Standards of Practice. [Supplemental Material] Journal of Infusion Nursing, 34 (1 Supplement), S43. MacLean, S., Obispo, J., & Young, K. (2007). The gap between pediatric emergency department procedural pain management treatments available and actual practice. Pediatric Emergency Care, 23, 87-93. doi: 10.1097/PEC.0b013e31803 McNaughton, C., Zhou, C., Robert, L., Storrow, A., & Kennedy, R. (2009). A randomized crossover comparison of injected buffered lidocaine, lidocaine cream, for peripheral intravenous cannula insertion. Annals of Emergency Medicine, 54, 214-220. doi: 10.1016/ j.annemergmed.2008.12.025 Singer, A., Taira, B., Chisena, E., Gupta, N., & Chipley, J. (2008). Warm lidocaine/tetracaine patch versus placebo before pediatric intravenous cannulation: A randomized controlled trial. Annals of Emergency Medicine, 52, 41-47. 0% 20% 40% 60% 80% Yes No Prior to viewing the video, were you familiar with this technique? 0% 20% 40% 60% Yes No To date, have you attempted to place an IV in the clinical setting? 0% 20% 40% 60% Yes, placed an IV using this technique No, have not placed an IV using this technique No, have not placed an IV Have you used lidocaine when inserting an IV for a patient in the clinical setting? 0% 0% 0% 7% 7% 20% 26% 13% 0% 27% On a sale of 1 to 10, how likely are you to consider using this technique in your professional practice? 1--Definitely will not 2 3 4 5--Unsure 6 7 8 9 10-- Definitely will Abstract This project was established to increase awareness among nursing students about a technique they can use to decrease the pain their clients experience during intravenous (IV) catheter placement. While the Infusion Nurse Society recommends using the least invasive methods first (i.e. topical lidocaine cream), I have chosen to develop a video demonstrating the use of injected buffered lidocaine because the technique required is more advanced than applying a cream to the skin. Initially, this project will impact the students following me in the nursing program by increasing their knowledge and skill base. On a grander scale, it has the potential to impact the patients these future nurses care for by decreasing the pain they experience with peripheral IV insertion. Project Sponsors: Washburn Transformational Experience (WTE) and Ralph W. Cain Memorial Scholarship, Topeka Post Office Credit Union Evaluation & Conclusions Overall, students found the video to be informative and helpful. Several students noted being exposed to this technique during time with IV therapy in clinical. It is encouraging to hear students are able to get this exposure, but I feel it also likely they would benefit more going in to their clinical experience with knowledge of this technique. Familiarity with this technique would allow them to maximize the potential of their time with IV therapy by engaging in conversation about the technique, asking their assigned IV therapist specific questions, and gaining practice using the technique if appropriate. One concern that arose from the student survey was sticking the patient twice by using this technique. The art of expertly and painlessly inserting an IV is not a skill that is acquired without much practice. In order to gain competency with IV insertion, this technique could be a useful tool. As with all treatments and procedures, this technique should only be used when the risks outweigh the benefits. Development of a brief PowerPoint could also be helpful for covering material not explicitly covered in the video, such as the adverse effects of lidocaine. Also, because this video is not intended to be the sole resource used for information regarding this technique, students should be encouraged to seek more information from available resources. NURSINGTM