title: Registered nurses' choices regarding the use of intradermal lidocaine for intravenous insertions: the challenge of changing practice.
abstract: After a policy change that required that lidocaine be offered to every patient before an intravenous (IV) insertion, registered nurses (RNs) in this rural acute care hospital were interviewed to determine whether they had changed their practice. This study reports on the percentage of RNs who offered lidocaine before IV insertion and explores the perceived and actual barriers for those nurses who did not routinely offer patients this option. The study sample of 30 represents 8% of the RN inpatient staff. Of the sample, 30.0% said that they always offer intradermal lidocaine and reported a decrease in patients' pain, fear, and anxiety as advantages. Another 23.3% of the RNs indicated they offered lidocaine only in specific circumstances based on patients' behavior and condition and the IV site to be used. The remaining 46.7% responded that they do not offer lidocaine. The reasons for not offering lidocaine included the perception that it made the procedure more difficult, an acknowledgment that it was not a part of their routine, or they did not think of it. Both the RNs who used the lidocaine and the RNs who did not use it referred to the fact that there was poor staff knowledge and skill about how to use intradermal lidocaine successfully. Recommendations are made for addressing the identified barriers.
authors.affiliation: School of Nursing, California State University, Chico, CA 95929-0200, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Brown
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000451:nursing*; D002755:Choice Behavior; D002983:Clinical Competence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006780:Hospitals, Rural; D006801:Humans; D007262:Infusions, Intravenous / Q000451:nursing*; D007271:Injections, Intradermal; D008012:Lidocaine / Q000627:therapeutic use*; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014193:Trauma Centers
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine