In ASCs We Trust!
August is National ASC Month, a month when employees, owners and advocates of ambulatory surgery centers celebrate and increase awareness of the many benefits...
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By: Irene Tsikitas
Published: 5/12/2010
"Ouch!" It's the one thing you don't want to hear when you're inserting the needle and catheter to start a patient's IV. Yet the pain-free IV start remains something of a holy grail in outpatient surgery. More than half of the 118 surgical facility managers who completed our online survey last month say patients complain of painful IV starts sometimes (52%) or frequently (6%). "The IV start is often the one thing that patients complain of most during the procedure," says Kathy LeSage, RN, director of St. Luke's Surgical Center in Tarpon Springs, Fla. Still, many seasoned nurses and anesthesia providers say there are ways to ease patients' pain when needle meets skin. Read on for their best tips on getting an ouchless IV start every time.
Take your time locating the vein
Many of our poll respondents agree that the key to a painless IV start is to find the right vein the first time. While the pressure is often on to do things quickly, there's little to be gained from rushing through the IV start. "Be patient. Use your fingertips as well as your eyes," says one facility manager. Some other tips for finding the perfect vein:
Reader Survey Results |
Patients at my facility complain about painful IV starts _____ Products or Techniques Used to Lessen the Pain of IV Starts SOURCE: Outpatient Surgery Magazine Online Reader Survey, April 2010, n=118 |
Put patients at ease
The "distraction method" is a popular way to put the patient at ease when it's time for the needlestick. After all, the patient who sits in dread, wincing and squirming as you approach with the needle, is more likely to feel pain than the patient who's chatting amiably about the weather during her IV start. You can distract patients by initiating pleasant conversation (any topic other than the reason for their surgical visit will do), scratching the skin a few centimeters away from the IV site, having the patient turn his head slightly and cough just as you're about to insert the needle or having him hold his breath and then let it out just as you insert the catheter.
Whatever distraction method you use, don't catch patients totally off-guard. "Make sure to tell them when you're going to stick them; it seems to hurt less if they know it's coming as opposed to sneaking up on them," says one surgery center manager. A hospital administrator says you can surprise patients another way by pinching the site first: "Inform the patient that's as bad as it will be. The needlestick surprises them with how little it hurts since they were sensitized to the skin pinch."
To numb or not to numb?
Nearly one-fourth (23.7%) of survey respondents say they use topical anesthesia, such as a spray or ointment, to numb the skin at the insertion site. Nearly two-thirds (61.9%) say they inject a local anesthetic, such as 1% buffered lidocaine, subcutaneously to lessen the pain of the IV start. While some believe the analgesic effects of such an injection are not worth the extra needlestick required, many said the benefits outweigh the costs. "Use an adequate amount of local anesthesia and rub it in and around the vein," says James A. Ramsey, MD, chief of anesthesiology at the Aesthetic Surgery and Laser Center in Nashville, Tenn. "Yes, it is a stick, and some people go 'ouch,' but it gives you a good idea of what their pain threshold is and if they might need stronger analgesics for the trip home."
Some tips for success with lidocaine injection:
Ask for help
Patients don't want to feel like pin cushions or practice dummies for unskilled nurses. Part of your IV therapy training should involve teaching nurses when to say "when." Create a policy requiring them to seek assistance after a certain number of failed attempts. "Our rule is: 2 sticks, then get another nurse or CRNA to try," says Ms. Sabin. At the Heart of America Surgery Center in Kansas City, Kan., Medical Director Phyllis Steer, MD, says they don't even let it get to that point: "If [the vein's] not found, the nursing staff doesn't even attempt the IV start but calls anesthesia to help."
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