Intradermal Lidocaine for IV Starts

Intradermal lidocaine for IV starts has been used in multiple hospitals to help reduce pain. It does require that a patient receives at least 2 needle insertions for every IV procedure. The first needle stick is done to inject the lidocaine. The second needle stick is for the IV insertion, to place the catheter. This process can be quite painful and even cause patients to become discouraged when they are wanting an option for an anesthetic effect, prior to their needle procedure. Intradermal lidocaine for IV starts, is a cost-effective way to provide anesthesia to the skin prior to routine procedures. However, it does not take into consideration the concerns of the patient receiving the care. If this has also been a concern of yours, there are products available that can be a positive alternative.

How to Inject Lidocaine Subcutaneously

Facilities that are using intradermal lidocaine prior to painful needle procedures, can easily switch over to a needless option called the J-Tip™. The J-Tip uses jet injection technology to provide a completely needle free way to numb the subcutaneous tissue, by using lidocaine before IV starts.

How to inject lidocaine subcutaneously: The J-Tip propels the lidocaine into the subcutaneous tissue without the use of a needle. It uses CO2 gas to propel the piston forward to create a fine stream of liquid anesthesia. As the medication exits the device through a small orifice it passes through the skin creating a spray like pattern into the subcutaneous tissue, allowing for broad dispersion and quicker absorption. This may help busy hospital staff start medical procedures faster and more efficiently. It also provides a way of delivering FDA approved medication virtually pain free to patients. By using the J-Tip you can achieve an anesthetic effect within 1-2 minutes and lasts up to 15-20 minutes.

Many hospitals across the country are currently using the J-Tip facility wide as a pain management tool in their departments to help decrease the pain that is associated with IV starts. It is also used prior to multiple procedures such as: blood draws, lumbar punctures, PICC insertions, and minor surgical procedures.

You might wonder, why not just use a standard needle with lidocaine? To answer that question: yes, using standard lidocaine in a syringe is generally a more cost-effective route to take but are you really putting the needs of your patients’ first and addressing their pain before they brave a needle procedure. The pain of the medication can be far worse than the initial pinch of a needle. Not only does the patient have to receive multiple needle sticks for a procedure but they also endure the sting associated with standard lidocaine.

Buffered Lidocaine for IV Starts

If you have you have ever had an injection with standard lidocaine you might have experienced the painful sensation of stinging and burning that can be quite painful.  So, again I ask, are the patients’ needs really being met when it comes to addressing pain management with IV starts? By using the J-Tip it offers an anesthetic option to patients without the use of a needle. It also can benefit the staff by helping to reduce the risk of an accidental needle stick injury.

There are medications that can be used as an alternative to standard lidocaine that can help to minimize the stinging and burning sensations as it enters the tissue. Buffered lidocaine1 has a pH level that can minimize the sting or burn associated with standard lidocaine2. It does however, have a shorter shelf life compared to standard lidocaine and must be compounded by a pharmacy3. The J-Tip needle-free injector is most frequently used with 1% buffered lidocaine for IV starts.

In the past there has been a shortage of sodium bicarb which is an ingredient within buffered lidocaine. In that case, 1% Xylocaine®-MPF (Methylparaben Free) can be used as an alternative in the J-Tip.  1% MPF lidocaine is usually readily accessible and it also comes in a vial. It may have a longer shelf life when compared to the compounded buffered lidocaine. From my own experience, 1% MPF lidocaine does have a slight sting when it initially enters the subcutaneous tissue but dissipates almost immediately. With that being said, using 1% buffered lidocaine for IV starts is generally preferred when using the J-Tip especially when treating children.

Many facilities have adopted this device site wide to include departments such as Emergency, Pediatrics, Radiology, Pre-Op, infusion centers and many more. Using lidocaine intradermally and subcutaneously is an option that can help to address pain management for IV starts. The J-Tip is a tool that allows you to use this method without the use of the needle. This quick and easy method can make a considerable difference in patient satisfaction. It’s time we start making patients’ satisfaction a top priority at medical facilities.


  1. McNaughton C, Zhou C, Robert L, Storrow A, Kennedy R. (August 2009) , A randomized, crossover comparison of injected buffered lidocaine, lidocaine cream, and no analgesia for peripheral intravenous cannula insertion Retrieved May 15, 2018 from:
  2. PAUL O. LARSON MD, GANGARAM RAGI MD, MARY SWANDBY RPh,  BARBARA DARCEY,  GREG POLZIN PATRICK CAREY, (May 1991), Stability of Buffered Lidocaine and Epinephrine Used for Local Anesthesia, Retrieved on Apr 17,2018 from:
  3. Sapin P, Petrozzi R, Dehmer GJ (June 23, 1991), Reduction in injection pain using buffered lidocaine as a local anesthetic before cardiac catheterization, Retrieved Apr 13, 2018 from: