Dr. Joel Aronowitz - Lidocaine Preparation:Tips and Tricks for Preparing and Injecting a Local Block!
 |
| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So, if I'm doing an aspiration, then when I aspirate, that means to draw off fluid with a needle. I'm going to usually want to numb up the area before I put the needle in. So, the needle you're going to aspirate with is usually a bigger needle, and unless the area is numb, you want to numb that little area with a smaller needle and some lidocaine so that the patient doesn't feel the bigger needle. And then you never want the patient to see the needle. The N-word for us is needle. You don't want people to hear the word needle, and you don't want people to see the needle. So, you want to be discreet about that because it's scary. I'm scared of needles, and I don't even... They're not after me. So, what we do is we'll take a smallish syringe, so something like either a 3cc or a 5cc syringe or a larger syringe if that's not available. And then we're going to draw the lidocaine up with either a 23 or an 18 piece here. And then we're going to aspirate with a larger needle. So, I'm just going to do this with my bare hands because we're not going to use this on a patient.
Do you see? We're in class. Do I get an M.A. for my room that I'm about to go in, or...?
As soon as we're done, you can. Okay, so it's actually a little bit controversial about whether or not you need to clean the rubber stopper with alcohol. It's common practice, but it actually may weaken the rubber more than it prevents any bacterial contamination. So, typically, we're going to draw up a little bicarb, and we'll do that part first. And the purpose of the bicarb... Does anybody know the purpose of the bicarb? Right, it neutralizes the acidic lidocaine. The lidocaine is supplied with an acidic pH so that it acts as a bacteriostatic. It prevents the bacteria from growing. It doesn't really matter how much of the buffer, so usually like half a cc or less, because you don't need much OH to neutralize the Hs in the acid. And then we'll draw up a little lidocaine. So, in order to raise a wheel... Does anybody know how to spell wheel that I'm talking about? W-H-E-A-L, not a W-H-E-E-L, wheel is that little bump that you get from a bee sting, or you get from injecting into the dermis, and you get a little bump. That's called a wheel. And that's what we're doing, because we want to numb up the skin, and we want to numb it So within a minute or two, I can put a needle through it, and it doesn't hurt the patient. So now I have drawn up the lidocaine, one or two ccs of lidocaine, a little less bicarb, and then I'm going to put on either a 27 or a 30 gauge needle that I can give the patient to administer a little bit of lidocaine in the skin so that I can penetrate the skin with a larger needle. So, if you give me that, or even 27, I can distract the patient a little bit, raise a little wheel before they know it, and then the whole experience doesn't hurt. If they see that, it will scare them, and they will experience a lot more discomfort if they see me preparing, or they see you preparing that, and there's medicines, there's needles, there's noise, there's things clanging, tools clanging. It's a very scary experience for the patient, because for us, we know we're not the victim, but the patient knows all this is for them, and they're worried about, is it going to hurt? So, if you do that discreetly, that helps a lot. And then usually when I'm drawing out, I'm aspirating a seroma or something else, it's going to be with a 60 cc syringe and an 18 gauge needle for me. Sometimes I'll use a little seroma catheter if you're not sure you can ask. The seroma catheter is a little blunt tipped catheter. Any questions?”
Participant: “Why did you draw up the bicarb first?”
Dr. Joel Aronowitz: “Because if you draw up the lidocaine first, you're going to contaminate the bicarb with lidocaine. So, you can afford to contaminate the lidocaine with bicarb. And obviously, if any of these things was used on a patient, you don't want to use that same thing on a multi-dose vial. Generally, we're moving away from multi-dose vials, but while we're using multi-dose vials, you want to be very aware, even if you didn't inject or draw anything, if any of this part was used on a sterile field where the patient's bodily fluids, blood, whatever, has already been exposed, you don't want to contaminate a multi-dose vial with that. You can transmit infectious diseases that way. The other thing to know about this is sometimes you'll get it. It'll cause precipitation of the lidocaine. If you do this with marcane, it'll cause precipitation. Sometimes it will make this cloudy. It doesn't hurt anybody. It just causes a little more pain on injection. But if it turns cloudy, usually I'll start over. But that's because it's caused a precipitation of the lidocaine. So, what you have there is not a solution. Do you know what you get if you have it? If it causes precipitation of the material that was in solution and now it's out of solution and it's cloudy, what's that called? An emulsion. Do you know the word emulsion?
So, an emulsion is solids suspended in fluid, but it's not really dissolved. To be dissolved, what does it have to do? Asla, you're the medical school admittee genius. To be in solution, what do you have to do? You have to... the material, that molecule, if it's suspended, it's just sitting there suspended in the water if it's aqueous or alcohol, whatever. But if it's in solution, it disappears completely. What's the difference? Well, when it dissolves, you have...it's an aqueous solution that we're talking about? It doesn't matter. If it's in solution, the two parts of the molecule, if it can be dissolved, there's a plus part and a minus part. It ionizes. It separates like sodium and chloride separate in water. It ionizes and they're in solution. And then when they precipitate, they get back together and you get solid salt again. So that's the difference between something in solution and not in solution, whether it's water or alcohol or something.”
Comments
Post a Comment