In the clinic where I work, some nurses give patients an intradermal injection of 1% lidocaine for local anesthesia before inserting an I.V. device. Is this within a nurse's scope of practice?-M.K., N.M.

Only if the nurse is following a prescriber's order or standing orders. According to the Infusion Nurses Society (INS) Standards of Practice, facilities should have policies and procedures on the use of local anesthesia, in accordance with the state's Nurse Practice Act and rules and regulations promulgated by the state board of nursing. If your facility doesn't have such guidelines, work with prescribers at your clinic to develop a standing order and a policy and procedure based on INS guidelines. The standing order should specify the dosage and concentration of lidocaine to be injected. To review the injection procedure, see "On the Road to I.V. Starts," (August 2007) in the Archives at http://www.nursing2007.com.*

The INS recommends applying a topical anesthetic before painful dermal procedures in children, but the use of intradermal lidocaine is controversial because of the slight risk of allergic reactions, tissue damage, or inadvertent injection of the drug into the bloodstream. Less invasive options include iontophoresis, low-frequency ultrasonification, and pressure-accelerated lidocaine, according to INS practice criteria related to the standard for local anesthesia. Assess your patient for allergies before administering any drug and closely monitor him afterward for adverse reactions.

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