Medicine’s Barbaric Little Secret: IV’s Don’t Have to Hurt

I was speaking to an old friend, a fellow physician, the other day about what makes hospitalized patients most uncomfortable. Incredibly, one of the things he told me was that when he is doing rounds in the intensive care unit (ICU), the blood drawings for the daily testing take place around 4:00 AM. I was shocked! How can patients get adequate rest when someone is jabbing a needle in their arms at that ungodly hour?

This led to a discussion about what doctors and nurses do to patients that, in my opinion, border on barbarity. One of them is starting intravenous lines with no local anesthesia on the skin. I consider this one of medical practice’s dirty little secrets. Let me explain…

When I entered anesthesia training in 1986, I was introduced to a practice that has long been the standard of anesthesia personnel, from physician anesthesiologists to nurse anesthetists to anesthesia assistants and pre-op nurses: the use of local anesthesia on the skin to start an IV.

When I was an internal medicine intern and medical student, I witnessed the unnecessary infliction of pain on patients who had their IVs started without local anesthesia, often by inexperienced students and interns. This horrible and immoral practice was just considered the norm. It wasn’t intentional, it was just the way things were done.

In 1986, as a new anesthesia resident, I was taught how to start an IV and, more importantly, how to do so relatively painlessly: with the use of less than 1 cc of the local anesthetic lidocaine. What we were taught is still in practice by many in my specialty today. A small wheal (bubble) of local anesthetic is applied with a tiny (and I mean tiny!) needle just where the IV is to be started in the vein. After five seconds, the practitioner can, with virtually NO pain to the patient, search for and find the proper site for insertion of the IV catheter. I know this to be true because, in my estimation, I’ve done this an astounding 80,000 times (you read that right) over a nearly 32-year career.

There is absolutely no reason that this should not be standard practice for every patient in need of an IV. The training takes five minutes and the results are dramatic. The amount of lidocaine administered is so minute that it causes no ill effects. And the patients are spared the painful ordeal of IV starts, especially when multiple sticks are involved.

My physician friend and I agreed that another area where this can be employed is when an arterial blood gas is drawn. This procedure is even more painful than an IV start. A needle is inserted into an artery to obtain an arterial blood sample for analysis. Let me tell you, it hurts like hell. Yet health care personnel still inflict it and patients endure it.

So, let 2019 be the year that patients stand up for themselves. Let it be the year that health care professionals ease the pain of patients. And let it be the time that Bottom Line put the message out: this barbaric practice is unnecessary and unwarranted. A touch of lidocaine in the right hands can make all the difference in the world!

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