A Randomized, Crossover Comparison of Injected Buffered Lidocaine, Lidocaine Cream, and No Analgesia for Peripheral Intravenous Cannula Insertion.

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A Randomized, Crossover Comparison of Injected Buffered Lidocaine, Lidocaine Cream, and No Analgesia for Peripheral Intravenous Cannula Insertion.

Ann Emerg Med. 2009 Feb 12;

Authors: McNaughton C, Zhou C, Robert L, Storrow A, Kennedy R

STUDY OBJECTIVE: We compare pain and anxiety associated with peripheral intravenous (IV) cannula insertion after pretreatment with no local anesthesia, 4% lidocaine cream, or subcutaneously injected, buffered 1% lidocaine. METHODS: In a randomized, crossover design, 3 peripheral IVs were inserted in each of 70 medical students or nurses. In random order, insertion sites were pretreated with nothing, lidocaine cream, or injected, buffered lidocaine. After each IV insertion, subjects recorded pain, anxiety, and preference (as patient and provider) for each technique on a 10-point numeric rating scale. Higher scores indicated greater pain, anxiety, and preference. RESULTS: Median pain scores (interquartile range [IQR]) were 7 (4 to 8) without local anesthesia, 3 (2 to 5) with lidocaine cream, and 1 (1 to 2) with injected, buffered lidocaine. Median anxiety scores (IQR) were 4 (2 to 7) without local anesthesia, 2 (1 to 4) with lidocaine cream, and 2 (1 to 3) with injected, buffered lidocaine. There was no detectable difference in anxiety scores between lidocaine cream and injected, buffered lidocaine. Most IV placement attempts were successful, regardless of technique. Seventy percent of subjects indicated they would "always" request buffered lidocaine for peripheral IV insertion. CONCLUSION: In adult health care providers, pain and anxiety associated with peripheral IV insertion is significantly reduced by using topical lidocaine cream or injected, buffered lidocaine. Injected, buffered lidocaine reduces IV insertion pain more than lidocaine cream, without affecting success. Adults desire the use of local anesthetic techniques for IV insertion for themselves and for their patients.

PMID: 19217695 [PubMed - as supplied by publisher]


  1. Intra venous Cannula (IVC) – as well as word ‘venfon’ – is hated by all, especially patients and house officers. The former dislike it because it is painful, whereas the latter are repulsed more by the fact that inserting cannulae on regular basis is such a sub-cortical job (GMC Today).

    Of all vascular access devices, peripheral venous cannula is the most frequently used in healthcare. The number of staphylococcal infection has rapidly increased since 1960s and this trend parallels the increased use of intravenous cannula. This is the only device that can “Save Life”, but must be inserted into blood vessels with care and meticulously monitored. These bacteria are now said to be resistant to biocides used to clean skin which makes insertion a major risk factor.

    Doctors and nurses claim the bad veins, dodgy veins, thrombosed vein and so the cannula manufacturers claim doctors and nurses find it hard to locate a vein, but we have found this claim is not true. The number of attempts taken to be successful is 2-3 attempts. Blood collection noticed in the blood chamber in every failed attempt seen in the discarded cannula indicate the vein is punctured.

    These bacteria are commonly carried on the skin around 30% of the healthy people. Multiple puncture will allow CA-MRSA to enter the vein resulting in phlebitis, septicaemia and death.

    We hope the doctors will organising studies to find the number of attempts taken to insert cannula, infections associated with multiple attempts, problem with ported cannula and the cost of discarded contaminated waste in the hospitals, than wasting time repeating what others have already proved.

  2. Do you incorporate a pain assessment in your documentation for your IV starts?

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