The use of local anaesthesia in peripheral venous cannulation: current practice of junior doctors

Abstract

Objective: To determine the rate of use of local anaesthetic in peripheral venous cannulation by pre-registration house officers and to determine reasons why they do not use it.

Design: Analysis of anonymous questionnaires distributed to pre-registration house officers at scheduled weekly education meetings.

Setting: One regional hospital and three district general hospitals in the United Kingdom.

Results: 71 questionnaires were distributed directly to respondents and subsequently analysed. 46 respondents (65%) stated that they never used local anaesthetic for peripheral venous cannulation. Of those who used local anaesthetic the average rate of use was 6%. Of those who used local anaesthetic 48% stated they used EMLA and 84% stated they used lignocaine. 4% stated they would use local anaesthetic for 22 gauge cannulae, 8% would use it for 20 gauge, 24% for 18 gauge and 40% for 16 gauge and 28% for 14 gauge cannulae. 45% stated that using local anaesthetic was too time consuming, 35% stated it was not indicated, 21% stated that it made cannulation difficult, 13% stated that local anaesthetic was not available on the ward, 13% stated that it was logistically difficult, 4% stated that there was peer pressure not to use it, 4% stated they were not allowed to use local anaesthetic and 3% stated that it was practically difficult. 20% of respondents gave no reason.

Conclusions: Despite good clinical evidence that the pain of peripheral venous cannulation can be successfully obviated using local anaesthetic, the rate of use by pre-registration house officers is low. It is suggested that during formal cannulation training, more emphasis be placed on the provision of analgesia. This should aim to increase the quality of care to those patients requiring intravenous cannulation as well as offering other potential benefits to doctors.