Take note
of the new Procedural Pain Protocol
The new Procedural Pain Protocol was implemented on March 14.
This protocol allows nurses to use medications to prevent pain
for procedures identified in the protocol automatically for
each patient who enters our main campus or health centers. An
order is required to exclude patients from the protocol,
rather than the customary requirement of an order to allow
patient participation.
The procedures are those performed by nurses: PIV access,
implanted port access, venipuncture and IM injections. The
medications are sucrose, LMX 4 percent lidocaine cream,
LidoSite iontophoresis system delivering Lidocaine with
Epinephrine, buffered lidocaine injection, and ethyl chloride
spray.
This is a new expectation of children being entitled to pain
prevention for these procedures. The addition of the protocol
and two medications to formulary is intended to remove
barriers to achieve this goal of pain prevention.
|
Procedure |
Age |
Recommended Analgesic
|
Onset
|
|
PIV
insertion
|
< 6 months |
Sucrose |
2 mins |
|
BOTH Sucrose and L-M-X for procedures
expected to last several minutes |
30 mins |
|
> 6 months |
L-M-X |
30 mins |
|
LidoSite (> 5 years) |
10 mins |
|
Buffered Lidocaine (> 5 kg) |
Immediate |
Venipuncture
|
< 6 months |
Sucrose |
2 mins |
|
> 6 months |
L-M-X |
30 mins |
|
LidoSite (> 5 years) |
10 mins |
Port A Cath access
|
|
L-M-X |
30 mins |
|
Lidosite (> 5 years) |
10 mins |
|
Ethyl Chloride Spray |
Immediate |
IM Injections
|
< 6 months |
Single Injection: Sucrose |
2 mins |
|
Multiple Injections expected to last
several minutes: Sucrose and L-M-X |
30 mins |
|
> 6 months |
L-M-X |
30 mins |
Choice of modality should be based upon urgency of the
procedure, patient age, contraindications, patient
preference, and clinician expertise.
Approved by Pharmacy and Therapeutic (P&T) Committee 1/11/06.
Implementation date: 3/14/06.
Automatic protocol-physician order required to EXCLUDE patient
from protocol.
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