http://doi.org/10.33698/NRF0121 – Salma ,Sukhpal Kaur,Ashish Bhalla
Abstract : Intravenous (IV) cannulation is usually associated with pain and may be a source of discomfort and stress for the patients. The application of Lignocaine hydrochloride at the site prior to peripheral intravenous cannulation has been shows to decrease the intensity of pain. However it may affect the vital signs of the patient. This study was carried out to ascertain the effect of ‘Lignocaine hydrochloride 2% jelly’ application at the site prior to peripheral intravenous cannulation on vital signs of the patients. Using systematic random sampling technique 105 adult patients were randomized into control and experimental group. The lignocaine jelly was applied at the dorsum of hand or inner aspect of forearm for 30 minutes in experimental group. After 30 minutes jelly was removed and procedure of IV cannulation was performed. Vital signs were checked before and after IV cannulation in the both the groups. Significant changes in vital signs were observed among subjects of experimental group. The respiratory rate significantly increased from 19.96 ±2.32 to 20.46 ±2.04 (p<0.05). In relation to pulse, there was significant decrease from 86.29 ±15.33 to 85.92 ±16.58 (p<0.05). Statistically significant decrease in diastolic blood pressure was also observed. The difference in vital signs was statistically insignificant in control group. It was concluded that ‘Lignocaine hydrochloride 2% jelly’ application at the site prior to peripheral intravenous cannulation affect the vital signs of the patients.
Key words :
Blood pressure, pulse, respiration, lignocaine hydrochloride 2% jelly, IV cannulation.
Correspondence at :
Sukhpal Kaur
Lecturer,
National Institute of Nursing Education, PGIMER, Chandigarh
Introduction
Intravenous (IV) cannulation is one of the most common invasive procedures among patients admitted in hospital. About half of these patients receive intravenous therapy during their stay.1 The procedure is associated with pain. There have been considerable amount of efforts over the past several years to identify methods of decreasing pain associated with IV cannulation. These include the use of topical skin coolant, warm lidocaine / tetracaine and nitrous oxide and laser assisted topical anaesthesia.2-7 The efficacy of lignocaine gel for anesthesia of mucous membranes is well established.7 Since years lignocaine has been tested for its use in order to decrease intensity of pain during intravenous cannulation.
Lidocaine or xylocaine is a common local anesthetic and antiarrhythmic drug. It is used topically to relieve itching, burning and pain from skin inflammations and injected as a dental anesthetic or as a local anesthetic for minor surgeries.
Cardiovascular manifestation of xylocaine jelly 2% are usually depressant and are characterized by bradycardia, hypotension, arrhythmia and cardiovascular collapse8. A double blind study was carried out by Saxena et al to compare the effects of Lignocaine gel (2%), EMLA (Eutectic Mixture of Local Anaesthetics) and Vaseline jelly (placebo). A comparison of the change in vital parameters from initial to post cannulation was carried after application. There was significant increase in pulse rate in each group (p< 0.05). Systolic as well as diastolic blood pressure showed significant increase in Group II and Group III.7
The effect of topical and local anesthesia agents at the cannulation site has mainly been evaluated on the patients’ perception of pain. There is hardly any study which has seen the effects of all these agents on the vital signs of the patients. So, the current study was under taken with the objective to ascertain the effect of ‘Lignocaine hydrochloride 2% jelly’ application at the site prior to peripheral intravenous cannulation on vital signs of the patients.
Material and Methods
The study was conducted at Post Graduate Institute of Medical Education and Research, Chandigarh. 105 subjects from Day care centre and the department of nuclear medicine were enrolled for the study. In the day care centre the patients are cannulated for the administration of chemotherapy. In the department of nuclear medicine, the patients are cannulated for the administration of contrast for various diagnostic tests like thallium, Single-Photon Emission Computed Tomography, Bone Scan, Positron Emission Tomography scan etc.
A quasi-experimental research design was employed. Using systematic sampling technique, subjects were alternatively placed in control and experimental group. All the odd numbered subjects were included in control group while the even numbered subjects were included in the experimental group. An interview schedule was developed to gather the patients’ information related to socio-demographic profile. Two protocols i.e. cannulation with and without prior application of ‘Lignocaine hydrochloride 2 % jelly’ were prepared. In the experimental group two gram ‘Lignocaine hydrochloride 2% jelly’ was applied over a 5×5 cm area over the dorsum or inner aspects of the forearm of subjects for 30 minutes. The agent was removed before the cannulation.
Vital signs were checked before the application of jelly and after cannulation (after the removal of jelly) in experimental group. In control group vital signs were checked just before and after cannulation. ‘t’ test was applied to assess the difference in mean vital signs.
Results
Age of the subjects ranged from 18- 78 in control group and 19- 76 in experimental group. Both the groups were comparable as per their age, gender, habitat, education, occupation and religion. (P>0.01, table 1). Both the groups were fur ther comparable in terms of the number of previous cannulation, purpose of cannulation, the size and site of administration of cannula as there was no significant difference between both the groups. In more than half of the subjects in both the groups 20 gauge cannula was used. Dorsum of the hand was the common site of insertion of cannula in both the groups.
Table 1: Socio-Demographic profile of the subjects in both the groups N=105
| Socio-Demographic | Control | Experimental | T, df | P |
| Profile | (n=53) f (%) | (n=52)f (%) | ||
| Age | ||||
| Mean (yrs) +SD | 54.28 yrs+15.03 | 49.17 yrs+14.05 | t=1.78, df=103 | 0.075* |
| Range | 18-78 | 18-76 | ||
| Gender | ||||
| Male | 30 (56.6) | 28 (53.8) | x2=0.08, df=1 | 0.776* |
| Female | 23 (43.4) | 24 (46.2) | ||
| Habitat | ||||
| Rural | 22 (41.5) | 19 (36.5) | x2=0.27 df=1 | 0.602* |
| Urban | 31 (58.5) | 33 (63.5) | ||
| Education | ||||
| Illiterate | 8 (15.1) | 8 (15.4) | x2=2.78, df=5 | 0.733* |
| Primary | 6 (11.3) | 9 (17.3) | ||
| Middle | 13 (24.5) | 11 (21.2) | ||
| Matriculation | 6 (11.3) | 9 (17.3) | ||
| 10+2 | 3 (5.7) | 4 (7.6) | ||
| Graduate &above | 17 (32.1) | 11 (21.2) | ||
| Occupation | ||||
| Not working | 34 (64.2) | 28 (53.8) | x2=1.84 df=2 | 0.397* |
| Manual workers | 12 (22.6) | 18 (34.6) | ||
| Others | 7 (13.2) | 6 (11.6) |
*p>0.05
‘t’ test was applied to find out the difference between vital signs before and after cannlation in both the groups. In experimental group there was significant rise in respiratory rate from 19.96+2.326 pre- cannulation (pre lignocaine application) to 20.65+2.04 post cannulation (p=0.03). In relation to pulse there was a significant decrease (p=0.03) from 86.29+15.33 to 85.92+16.58 after the Lignocaine application in experimental group. No difference in systolic blood pressure was observed, however significant decrease in diastolic blood pressure was observed. No significant difference in vital signs was observed in control group post cannualtion. (Table 2).
Table 2 : Comparison of vital signs among subjects of both the groups N=105
| Mean+SD | Range | Mean+SD | Range | ||
| Respiration | |||||
| Pre-cannulation/pre | 19.96+2.326 | 14-28 | 20.13+1.49 | 14-24 | |
| lignocaine application | |||||
| Post-cannulation/post | 20.45+1.61 | 16-24 | 20.65+2.04 | 14-28 | |
| lignocaine application | |||||
| ‘p’vaule | 0.14 | 0.03 | |||
| Pulse | |||||
| Pre-cannulation/pre | 85.40+13.99 | 52-120 | 86.29+15.33 | 62-124 | |
| lignocaine application | |||||
| Post-cannulation/post | 85.85+14.34 | 50-122 | 85.92+16.58 | 64-150 | |
| lignocaine application | |||||
| ‘p’vaule | 0.60 | 0.03 | |||
Vital signs Control group(n=53) Experimental group (n=52)
Systolic BP
Diastolic BP
Pre-cannulation/pre 140+22.44 110-210 139.04+18.655 110-170 lignocaine application
Post-cannulation/ post 142.79+23.83 110-200 140+19.55 110-180
lignocaine application
‘p’vaule 0.56 0.22
Pre-cannulation/pre 88.75+11.109 50-120 87.92+8.722 70-110
lignocaine application
Post-cannulation/ post 90.19+13.041 50-120 86.65+10.99 60-110
lignocaine application
‘p’vaule 0.42 0.01
Discussion
Current study is an attempt to ascer tain the effect of ‘Lignocaine hydrochloride 2%’ jelly, at the site prior to peripheral IV cannulation on vital signs of the patients. The intervention was carried out with the potential benefit to decrease the intensity of pain during IV cannulation. However, significant changes in the vital signs of the subjects were also observed.
Use of any pharmacological agent demands a close check on vital parameters of the patients. Xylocaine (lidocaine HCl) 2% Jelly is a sterile aqueous product that contains a local anesthetic agent and is administered topically. Excessive blood levels may cause changes in cardiac output, total peripheral resistance, and mean arterial pressure. These changes may be attributable to a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system. 8
In the present study it was observed that there was statistically significant rise in respiratory rate after the cannulation i.e. after the removal of jelly. In relation to pulse there was a significant decrease. A similar statistically significant decrease in diastolic blood pressure was also observed. No statistically significant difference in vital signs was observed in control group. As per the findings of a study by Sexena et al there was significant increase in the pulse rate, systolic and diastolic blood pressure in the patients in which lignocaine was used prior to IV cannulation.7 Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest.
Not many studies have been carried out to assess the effect of topical application of lignocaine on the vital signs of the patients. Though effect of local anesthesia before IV catheterization on the perception of pain has been reported in literature. A randomized, double-blind, parallel-design, quasi experimental study was carried out to compare the efficacy of intradermal bacteriostatic normal saline with that of intradermal buffered lidocaine in providing local anesthesia to adult patients prior to IV catheterization. The pain at venipuncture was measured by using a verbal numeric rating scale. Intradermal buffered lidocaine was demonstrated to be significantly superior to intradermal bacteriostatic normal saline in reducing the pain of IV catheterization (P = 0.007).9 Thus to conclude it is emphasized that though topical application of Xylocaine helps to relieve pain and discomfort in most people, it may have certain unwanted side-effects in some people. So, at the time of using such agents the vital signs of the patients should be checked frequently. Further studies are required to find out the effects of other anesthetic agents applied topically on the vital parameters of the patients.
References
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