How often has this happened to you --
You are in the middle of a sterile procedure (chest tube, suturing, central venous line, lumbar puncture) and you realize that you need more lidocaine to provide better topical anesthesia. You don't have any more in your kit and you are alone in the room with the patient.
"Uh, can someone help me out there?"
Trick of the Trade #1:
Keep extra lidocaine around for your painful, sterile procedures.
It's always when you don't have any will you need it. This is especially true for lumbar punctures. Why DO they package such a small volume of lidocaine in the kit? I typically use the pre-packaged lidocaine (usually only 3 cc) only as a backup vial and instead start the procedure with 10 cc of lidocaine, which I've gathered from outside the kit.
Trick of the Trade #2:
Tape a bottle of lidocaine (or bupivicaine) securely to a gurney edge or wall.
If you don't have an assistant during your sterile procedure to hold the bottle up, create a setup so that you don't need an assistant. Before donning your sterile gloves, clean the top of the bottle with an alcohol wipe. Tilt the bottle downward so you can draw up the entire contents, if needed. Secure it on a gurney handle or even a wall. Be sure to securely tape the bottle, because sometimes the bottle slips out when you are either puncturing or withdrawing the needle from the bottle. You can slit a second piece of tape into a Y-shape formation to help secure the main taping job. Check out the photos.
(side view of bottle on gurney handle)
(top-down view of bottle on gurney handle)
(side view of bottle on wall)
For any residents -- I always keep the door open and a large crack in the curtain so I can yell for help.
ReplyDeleteLove it. The ultimate low-tech approach.
ReplyDeleteThis happened to me last night during my first solo suture experience in the ED. I wish I would have read this yesterday!
ReplyDelete- MS3
Another option is removing the lid of the lidocaine bottle (pretty easy,,pull up the tab then continue pulling it over and down the back side of the bottle removing the metal ring then the cap comes right off) then pour the lidocaine in one of the slots in the sterile tray and you can re-draw quickly from there.
ReplyDeleteInevitably I always wish I had read or looked up something before going on shift. That's what makes EM so exciting - something new every day!
ReplyDeleteAs for pouring in the lidocaine by pulling off the lid, that's another great trick. Usually there's sterile syringes and needles in the kit for whatever procedure you are doing already. You just then need to draw it up in your sterile well.