Pain free stick and shots

[mikeylikesit]

I was wondering if any of you who work either in the hospital or EMS field are proficient at pain free IV and Shots. i have gotten to a point in the ER that i can do blood draws without the patient saying they felt something. the IV's i have heard can be done without the patient enduring too much pain but i don't know how. Do any of you? now I'm not talking about the patient who has had soo many IV sticks that they don't feel them anymore like me, but the ones who are new to it.

 

[Hastings]

I was wondering if any of you who work either in the hospital or EMS field are proficient at pain free IV and Shots. i have gotten to a point in the ER that i can do blood draws without the patient saying they felt something. the IV's i have heard can be done without the patient enduring too much pain but i don't know how. Do any of you? now I'm not talking about the patient who has had soo many IV sticks that they don't feel them anymore like me, but the ones who are new to it.

Lol, that has entirely to do with the patient and not your skill. Everyone handles it differently, regardless of provider.

 

[mikeylikesit]

i have yet to encounter a blood draw patient thus far who felt any pain. i have had a ton of blood draws done on me...sometime i feel them other time i don't. there is a guy in Minnesota who showed my how to do it without feeling it.

 

[GonnaBeEMT]

i have yet to encounter a blood draw patient thus far who felt any pain. i have had a ton of blood draws done on me...sometime i feel them other time i don't. there is a guy in Minnesota who showed my how to do it without feeling it.

I do not know how it is done, but when I was a child I had an appendectomy at a small county hospital, and the anesthesiologist started my IV and I never felt a thing. I have no idea what size the needle was but I was amazed when he told me he was done because I was scared to death.

 

[GonnaBeEMT]

I found a study about skin anaesthesia I copied and pasted part of it here. You can google the cream and I am sure it will give you lots of info on it.

The effectiveness of skin anaesthesia after 5 minutes’ topical application of a lignocaine-prilocaine cream was evaluated. One hundred and twenty patients estimated the pain of antecubital venepuncture both on a linear scale and verbally after use of the cream for either 5 or 60 minutes, a placebo cream or no treatment. Reported pain was significantly less after only 5 minutes of the lignocaine-prilocaine cream (p = 0.002). The cream can be used to relieve the pain of all routine injections

 

[akflightmedic]

I am soooo good at giving shots and starting IV's that I NEVER feel a thing. (At least thats what I tell all my patients). Seriously, I do use that line to insert a little humor and lessen tension.

Them not feeling anything has absolutely nothing to do with you. It is individual and unique to each person provided you are doing it right. Now if you are rooting around and digging, well yeh once you become better they may not feel it and that will be a result of your skill.

But if you are saying you are just so good they do not feel it, that is quite the statement.

Anyways, every patient is different. Before giving injections or IVs, I consider the age of my patient, their demeanor, their apprehension level and determine how I am going to approach them. Most respond well to humor. Some need detailed explanation of what you are doing. Some want to watch, some don't. And some, you just have to jump right in and do it unfortunately (mostly kids) while they kick, scream and resist. My oldest daughter is in that group and she is always amazed at how quickly it is over and how it did not hurt, yet each time she went, she was so wrought with fear and apprehension, she made the situation so much more worse.

Just remember, confidence is great but please do not confuse it with cockiness. Maintain some humility and humbleness and you will go far...because the one time you think you "got this", that will be the time the fecal matter hits the fan, and you will be standing there going WTF???

 

[mikeylikesit]

I have used the xylocaine cream in the past and it works wonders on almost all my patients. i let it sit for 30 minutes if i have the time then i run the IV...(in the hospital not in the Ambo) But like AK said im usually not digging for a vein and get all my sticks the first time...usually.

 

[Airwaygoddess]

Let everyone know that Airwaygoddess hates shots......... numbing medication or not!

 

[Hastings]

I have used the xylocaine cream in the past and it works wonders on almost all my patients. i let it sit for 30 minutes if i have the time then i run the IV...(in the hospital not in the Ambo) But like AK said im usually not digging for a vein and get all my sticks the first time...usually.

Using anything to numb the nerves for an injection or IV is absurd, whether in the hospital or out. Not worth it in ANY circumstance.

 

[Ridryder911]

Using anything to numb the nerves for an injection or IV is absurd, whether in the hospital or out. Not worth it in ANY circumstance.

WTF? Who are you Superman or just sadistic? Really, you must have never had many injections or transfusions!

If my significant other/child was having her routine chemo or there was time allowed to place any anesthetic & you did not use such & proceeded to attempt* to start an IV, (*that is attempt, because you will have to pick yourself up off the floor), I would see that there was a report placed in your permanent file !

Not doing so is absurd! Be a patient advocate!

I routine give Lido intradermal, Cetacaine, (viscous does not work except on mucosa membrane); I have even given Fentanyl lollipops. Needles hurt.. and if you can prevent pain do so!.. Not doing is unethical.

R/r 911

 

[Hastings]

WTF? Who are you Superman or just sadistic? Really, you must have never had many injections or transfusions!

If my significant other/child was having her routine chemo or there was time allowed to place any anesthetic & you did not use such & proceeded to attempt* to start an IV, (*that is attempt, because you will have to pick yourself up off the floor), I would see that there was a report placed in your permanent file !

Not doing so is absurd! Be a patient advocate!

R/r 911

Yes, because paramedics often work in chemo departments. I assume the context of this thread, since being on EMTLife, is in regards to EMTs, whether in the hospital or in the ambulance. And I stand by my statement. Numbing agents aren't appropriate.

I'll tell you what IS reasonable. My policy of only attempting an IV once before asking someone else to try. And if it's not a patient that absolutely requires IV/Drug intervention, I wont try again. THAT is reasonable in an EMS situation.

 

[triemal04]

Yes, because paramedics often work in chemo departments. I assume the context of this thread, since being on EMTLife, is in regards to EMTs, whether in the hospital or in the ambulance. And I stand by my statement. Numbing agents aren't appropriate.

I'll tell you what IS reasonable. My policy of only attempting an IV once before asking someone else to try. And if it's not a patient that absolutely requires IV/Drug intervention, I wont try again. THAT is reasonable in an EMS situation.

That's all well and good, but the point still remains that some (many in fact) people will require some type of topical anesthetic, or analgesic before they have an IV started. That is, unless you like when the pt's anxiety level skyrockets, they begin to fight, scream, yell, cry, and stop allowing you to perform any of your other duties. And yes, even people that "need" an IV will do this. If you're preparing to start an IV on someone that starts getting worked up...why would you not use the adjuncts available to make it easier? Why would you not treat your patient appropriately?

I'm a big fan of nitrous oxide for this...short onset, short acting, and if they do manage to work themselves up, does wonders for calming them down.

 

[Hastings]

That's all well and good, but the point still remains that some (many in fact) people will require some type of topical anesthetic, or analgesic before they have an IV started. That is, unless you like when the pt's anxiety level skyrockets, they begin to fight, scream, yell, cry, and stop allowing you to perform any of your other duties. And yes, even people that "need" an IV will do this. If you're preparing to start an IV on someone that starts getting worked up...why would you not use the adjuncts available to make it easier? Why would you not treat your patient appropriately?

I'm a big fan of nitrous oxide for this...short onset, short acting, and if they do manage to work themselves up, does wonders for calming them down.

I'm a big fan of Nitrous too. Unfortunately, very few EMS providers carry it.

Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind. And in such a case, you find a way to do it through the fighting. Anyone else can wait until the hospital. And trust me, the hospitals around here wont give them anything for needle pain either. Mostly because the anxiety of getting a shot/IV is often not due to the pain at all.

But even beyond that, why won't I numb someone up for an IV? Besides time, that is? Because we don't carry anything that can.

 

[So. IL Medic]

WTF? Who are you Superman or just sadistic? Really, you must have never had many injections or transfusions!

If my significant other/child was having her routine chemo or there was time allowed to place any anesthetic & you did not use such & proceeded to attempt* to start an IV, (*that is attempt, because you will have to pick yourself up off the floor), I would see that there was a report placed in your permanent file !

Not doing so is absurd! Be a patient advocate!

I routine give Lido intradermal, Cetacaine, (viscous does not work except on mucosa membrane); I have even given Fentanyl lollipops. Needles hurt.. and if you can prevent pain do so!.. Not doing is unethical.

R/r 911

Sorry. That goes over the line for pain control. Are you considering giving Lido or Fentanyl before an accucheck stick? Admin a little dermal LIdo before the IV in a suspected ACS?

I think we have other things to worry about out in the field than the stress of an IV in an AC. Pain considerations are fine in hospital procedures of chemo or frequent repeated sticks in other procedures.

But would you really lay someone out in the back of a truck before they could start an IV on a family member clutching theor chest in much worse pain?

 

[Ridryder911]

Sorry. That goes over the line for pain control. Are you considering giving Lido or Fentanyl before an accucheck stick? Admin a little dermal LIdo before the IV in a suspected ACS?

I think we have other things to worry about out in the field than the stress of an IV in an AC. Pain considerations are fine in hospital procedures of chemo or frequent repeated sticks in other procedures.

But would you really lay someone out in the back of a truck before they could start an IV on a family member clutching theor chest in much worse pain?

C'mon use some common sense! Did you not read my posts? I said ..."if there was time allowed to place any anesthetic" as well, do you know how long it takes for me to apply Ethyl Chloride? .. 1 second, is that too long? Ever even seen the stuff? It comes in a spray bottle and wears off in a few seconds..I can have the IV site numbed & started before you can expel the air in a IV tubing or even a saline lock, I do it for some patients. Patients appreciate the added measure. There is a lot of difference between a FSBS and a 18g Jelco. (BTW I sometimes use the ear lobe for finger sticks, not as painful/sensitive afterwards and a good is a well perfused area) Would you not use viscous Lidocaine for an NG tube or even nasal intubation? Why would one ever not be sensitive the patient needs? Is this really good patient care?

Being ignorant about techniques just because one does not "carry or work" in a specific area is no longer tolerable. How do you think EJ's or any other procedure and treatment we use ever became popular in the field? It's called adaptation. Very few or any procedure was developed in the field for medical care. Medicine is medicine, no matter if it is in the truck, x-ray or CCU. The patient still has pain so does their pain threshold varies. As a healthcare professional you are responsible and held accountable for recognizing procedures that are painful & when possible eliminating the pain associated with these procedures.

If anyone considers nitronox or nitrous that maybe an overkill for just an IV. We are discussing simple local anesthetic for a simple procedure. Do I do it for all? ... no. Fortunately, I have mastered IV's that I can perform very fast, and successful usually without very much pain because the procedure is fast. However; there are patients and conditions that will allow me to perform the procedure.

What I do NOT tolerate is seeing a Paramedic or EMT "digging" around searching for a vein. Patient complaining of pain, and the patient being ignored. Many times the IV is usually for "protocol tx." and very doubtful that the patient will require medication or fluids enroute. I will remind the patient they have the right to refuse the IV, this ironically irritates some medics. Again, you are there for the patient, the patient is not there for you.

R/r 911

 

[mikeylikesit]

ah yes Ethyl Chloride...i use that when i do IV starts sometimes. The kids love it, it may give you a cold or slight stinging sensation but that IV won't make them cry.

 

[Hastings]

ah yes Ethyl Chloride...i use that when i do IV starts sometimes. The kids love it, it may give you a cold or slight stinging sensation but that IV won't make them cry.

Again, the best of patient care isn't doping up your patient (no matter how mild) for an IV start.

Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.

I can't remember the last time I gave a child an IV. Mostly because I never do unless they are dehydrated or need intervention immediately. And again, if a kid is at the point of NEEDING an IV, they're often not going to care.

 

[mikeylikesit]

Again, the best of patient care isn't doping up your patient (no matter how mild) for an IV start.

Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.

I can't remember the last time I gave a child an IV. Mostly because I never do unless they are dehydrated or need intervention immediately. And again, if a kid is at the point of NEEDING an IV, they're often not going to care.

Depends on your setting i stated above that the question was posted to not only EMS but any hospital workers as well. i use anesthetics because if i have the time it makes the patient less afraid to come back to me when they're sick or hurt again. i do go thought the whole rigmarole of explaining things to the patient before i begin, but some people just plain are afraid sometimes and if i have to change my approach to help them feel better than so be it.

 

[Ridryder911]

Again, the best of patient care isn't doping up your patient (no matter how mild) for an IV start..

It is quite obvious, you don't know much about topical anesthetics. I don't know what you are referring to as "doping up" a patient? You mean a temporary 15 second numbing agent at the spot it is sprayed at? Face it, you rather inflict pain. Sick kids (and adults) do care if they are even sick.. let's be realistic and humanistic. For those patients that don't care, chances are there is not much you are going to for them, and the IV will probably have to be an I/O.

Before making such statements; Why don't you ask to try some ethyl chloride on yourself then .. comeback and tell me how it "dopes up" anyone.. It is a topical agent that cools the site to make it numb.

I don't do it every time but we carry many topical agents.. Why not? What's your hurry? Why not take an extra 5 seconds to make a painful procedure more tolerable? Be humanistic to patients.

R/r 911

 

[Hastings]

It is quite obvious, you don't know much about topical anesthetics. I don't know what you are referring to as "doping up" a patient? You mean a temporary 15 second numbing agent at the spot it is sprayed at? Face it, you rather inflict pain. Sick kids (and adults) do care if they are even sick.. let's be realistic and humanistic. For those patients that don't care, chances are there is not much you are going to for them, and the IV will probably have to be an I/O.

Before making such statements; Why don't you ask to try some ethyl chloride on yourself then .. comeback and tell me how it "dopes up" anyone.. It is a topical agent that cools the site to make it numb.

I don't do it every time but we carry many topical agents.. Why not? What's your hurry? Why not take an extra 5 seconds to make a painful procedure more tolerable? Be humanistic to patients.

R/r 911

Doping is phrasing I found most appropriate for the use of Nitrous discussed previously, as it has an affect of ALOC. As well, it's the only one that is even carried within the lower half of this state to my knowledge. There's a reason we don't carry the agents you're speaking of. Because they're 100% unnecessary. But then again, having only worked in cities with the hospital mere minutes away, if a patient doesn't need an IV immediately, I have the luxury of being able to wait.