Use of Local Anesthesia for Arterial Punctures

Abstract

• Background Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture. • Objective To review the recommendations and studies related to the use of intradermal lidocaine to decrease pain during arterial punctures. • Methods Articles were identified by doing a systematic computerized search of MEDLINE (1980 to January 2006) to evaluate articles and reference lists of articles and a manual search of the references listed in original and review articles. English-language articles that evaluated any aspect of pain related to arterial puncture and cannulation, pain related to and methods of introducing lidocaine subcutaneously, and perceptions and use of local anesthesia for arterial or intravenous punctures were reviewed. • Results Except among anesthesia providers, the use of a local anesthetic before arterial puncture is not universal, contrary to the standard of practice. A number of false perceptions may prevent wider use of such anesthetics. • Conclusion Before a plan for behavior modification or policy change is recommended for use of local anesthesia to decrease pain associated with arterial puncture, further research must be done to determine nurses’ perceptions of use, actual practice, and currently established local policies.

Factors Influencing Nurses' Use of Local Anesthetics for Venous and Arterial Access

“…Hudson et al18 reviewed studies and recommendations related to the use of intradermal lidocaine to reduce pain during arterial punctures. The findings showed that the use of intradermal lidocaine before arterial puncture clearly decreased pain associated with the procedure and did not interfere with the success rate.…”

“…The use of local anesthesia facilitates successful IV cannulation and ABG sampling because of the reduction of associated pain and anxiety, which helps patients remain still during the procedure. According to Hudson et al,18 the administration of local anesthesia for ABG sampling was helpful in increasing the success rates of gaining arterial access because it minimizes patient movement during the procedure. Similarly, Crowley et al8 evaluated the success rate of injection and topical anesthetics; all reviewed studies indicated that the success rates were enhanced by the administration of local anesthesia.…”

“…Although the study was conducted 10 years ago, interestingly, the findings were consistent with the hypothesis of that study, in which 60% of anesthetists used local anesthesia for these procedures compared with 2% of ward physicians. Similarly, Hudson et al18 reviewed the literature and recommendations related to the use of intradermal lidocaine to decrease pain during arterial punctures. Although some articles reviewed in their study were old, they showed that, except among anesthesia providers, the use of a local anesthetic before arterial puncture was not universal.…”

“…They studied the practicality of using vapocoolant spray as a fast-acting topical anesthetic in the ED and found that this spray could produce the desired effect within less than 15 seconds after application 17,25. In their literature review, Hudson et al18 suggested that the effectiveness of lidocaine ointment, amethocaine gels, and transdermal creams, as alternatives to intradermal lidocaine, is limited in critical settings because of the lengthy application time required (30-60 minutes) to produce a sufficient effect. The findings concluded that ABG analysis was required in less time than allowed by use of topical anesthetics.…”

“…Papa and Zempsky24 stated that because of the rapid responses required in the ED, nurses working in the ED might be less likely to order pain control measures, which requires a physician's authorization, because of concerns regarding the consequent delay in treatment. Hudson et al18 agreed that the need for a physician's order to administer local anesthesia before arterial access is a barrier that limits the use of local anesthesia by nurses. Therefore, it was recommended that nurse managers establish standing orders to incorporate the use of local anesthesia (subcutaneous lidocaine) as a standard protocol for obtaining blood samples for ABG analysis 18…”