Fundamental Procedural Radiology Peri-Procedural Tasks: Administering Lidocaine Properly

Page Contents

1 OVERVIEW
2 MAKING A WHEAL WITH LIDOCAINE
3 GIVING LIDOCAINE DEEPER EXAMPLE: INTERNAL JUGULAR VEIN ACCESS
4 GIVING LIDOCAINE DEEPER EXAMPLE: PARACENTESIS

OVERVIEW

Administering lidocaine will be the first time that the patient’s skin is punctured. It is an opportunity to help control the patient’s pain and discomfort, however if not administered properly can lead to unnecessary pain and rattle the confidence of new trainees. It is a simple task but is nuanced. As a result look over the content below to learn more about how to administer lidocaine properly.

Key Points To Keep In Mind When Administering Lidocaine:

Use buffered lidocaine: lidocaine is acidic, and its administration will actually give a burning sensation as a result. To limit the pain from the lidocaine a buffered solution can be used. Typically 1% lidocaine is buffered with sodium bicarbonate (one part sodium bicarb to 9 parts 1% lidocaine).
Use the right size needle: typically a 25 gauge needle is used for injecting lidocaine.
Make an intradermal skin wheal first: the pain receptors are found in this layer, so it is important to make sure that this location is properly anesthetized with local anesthetic.
Begin your injection with the needle bevel up, parallel to the skin, and by dripping out your lidocaine as you break into the skin: this will ensure that once you enter the right layer of skin you being creating your wheal immediately (and helps avoid sticking in too deep unnecessarily). The video below helps demonstrate this technique in further detail.

MAKING A WHEAL WITH LIDOCAINE

When you are prepared to inject lidocaine, your first injection will be an intradermal injection (similar to placing a PPD) and your goal will be to make a skin wheal. This technique is shown in greater detail in the video below:

GIVING LIDOCAINE DEEPER EXAMPLE: INTERNAL JUGULAR VEIN ACCESS

The video below shows how lidocaine can be used to numb deeper tissues under ultrasound guidance. In this example lidocaine is used to prepare the deeper tissues for an internal jugular vein puncture under ultrasound guidance.

GIVING LIDOCAINE DEEPER EXAMPLE: PARACENTESIS

The video below shows how lidocaine can be used to numb deeper tissues under ultrasound guidance. In this example lidocaine is used to prepare the deeper tissues for a paracentesis under ultrasound guidance.

Page Updated: 03.24.2019