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Increasing ED Use of Jet Injection of Lidocaine for IV-Related Pain Management

Shobhit Jain1,2, Mary A Hegenbarth3,2, Sharon G Humiston3,2

  • 1Division of Emergency Medicine, Department of Pediatrics, and sjain@cmh.edu.

Pediatrics
|March 11, 2017
PubMed

Insights

Jet injection of lidocaine (JIL) effectively reduced pain during pediatric IV placements. This quality improvement initiative successfully increased JIL use to over 50% in the emergency department without impacting first-attempt success rates.

Area of Science:

  • Pediatric Emergency Medicine
  • Pain Management
  • Quality Improvement Science

Background:

  • Venipuncture is a significant source of procedural pain for children.
  • Jet injection of lidocaine (JIL) offers rapid pain relief for intravenous (IV) cannulation.
  • Its suitability for emergency department (ED) settings is recognized.

Purpose of the Study:

  • To increase the utilization of JIL for IV placements in a pediatric ED.
  • The goal was to raise JIL use from a baseline of 11% to 50% within 12 months.

Main Methods:

  • A quality improvement project was implemented in a tertiary pediatric ED.
  • Barriers to JIL use were identified through surveys.
  • Interventions included order set changes, education, workshops, improved accessibility, policy revisions, and reminders.
  • Data on IV placements were collected biweekly.

Main Results:

  • JIL use increased to 54% within 7 months, sustained above 50% for over 12 months.
  • First-attempt IV placement success rates were similar with JIL (76.4%) and without JIL (75.8%).
  • No statistically significant difference was observed in IV placement success rates.

Conclusions:

  • The project successfully and sustainably increased JIL use for pediatric IV placements.
  • JIL use did not negatively affect the success rate of first-attempt IV placements.
  • The initiative is being expanded to other institutional areas.
Abstract

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