Dialysis Pain and Lidocaine

I posted this a couple years back but it’s a popular topic for dialysis patients, new and experienced, so I’ll post it again to refresh it…

There’s a topical cream you can apply about 45-60 minutes before dialysis that may numb the area.  It’s called EMLA and it’s Lidocaine or Prilocaine at 2.5% concentration.  You can get it at a drug store and it requires a prescription.

A person at a dialysis discussion forum wrote about his experience with the cream:

“I have the Lidocaine+Prilocaine cream, but it works the same as the EMLA cream. It soaks in over the hour or two that you have it on and covered. When you get to dialysis, you take off the plastic/dressing and wash off the cream. It stays numb for another hour after that. I feel no pain at all with the lower needle. The upper needle can hurt a bit as it goes further in.

I spread on the cream thick enough that I can’t see my skin, about twice as wide as my fistula (that is, covering my fistula, plus 50% that width on each side past my fistula), and an inch above and below the highest and lowest stick marks. I don’t know yet if that’s too much – I guess I’ll see if I run out before I can refill the prescription! Then I wrap plain kitchen plastic wrap around my arm, not tightly, and tape the ends. If there are things I need to do that morning before dialysis, I use a large Tegaderm instead because it stays on better and doesn’t get in the way.”

When you start dialysis the prospect of a 15, 16 or 17 gauge needle being rammed into your arm is daunting… to say the least.  It was for me, too.  The techs referred to the sizes as “small, medium and large”.  That really doesn’t describe them well.   To my mind, they were all HUGE and, maybe, HUGER and HUGEST.  I described them to my friends as being about the size of the end of a ball-point pen.  The listener would squirm at the thought.  I knew at that point, they understood.

The logical solution to getting poked with that huge device is to inject Lidocaine before the stick.  For me it seemed a better alternative and so I requested it and the tech did it.  After a year or so, my very special tech, Krystal, began telling me that I shouldn’t use Lido as it causes scarring.  I struggled with this question for a while and then let her do one stick without it.  Given the sting of the Lido or the pain of the large gauge needle, it was actually less with the dialysis needle.  After a while, there is no pain at all as the area deadened to the poke.

A wise fellow using the pseudonym “Epoman” and who’s no longer with us had this to say in a posting about the topic,

…lidocaine works great however the medical community is split some say it’s bad for the graft some say the benefits outweigh the risk. I personally never wanted to take that chance and when I had a graft I never used Lido. And also I have never used it with my fistula. I would say the best thing for you to do is take the pain now and get the area nice and dead. The area where you stick the needles will deaden and you will eventually have very little if any pain at all. I have seen patients ALWAYS use lido and their graft is fine, so it is up to you. Or you can just use lido for a little while, say the first few months and slowly wing yourself off of it.

The pain involved with needle sticks is determined by many factors one being how sharp the damn needle is, I have had some really dull needles another is the skill of the tech/nurse, another is your own tolerance of pain and of course how fast the needle insertion lasts. If you have a tech/nurses who is sticking the needle in slow then the pain will last longer. I have seen techs/nurses put a needle in in about 1 second. Yes that’s right about 1 second and usually those were the talented ones. The longer you are at your center you will know which techs are the best stickers and which techs to avoid. Unfortunately some centers are really small so you may not have a choice that is when I recommend you learn to stick yourself.  (From http://www.IHateDialysis.com)

He has some very good advice and the scarring issue Krystal raised  is important.  Since I was on Lido for a couple years, I have to deal with that.  I have a large area that is scarred from repeated Lido injections.  The result is that it doesn’t heal as easily after the poke and sometimes it won’t clot as quickly so I have to be careful to give it sufficient time to clot and heal before I remove the bandages.  If I hadn’t stopped using Lido, it would be much worse.

There’s a topical anesthetic cream that you can apply an hour before being stuck and that seems to help in the first few months as you ease into the adventures of being stuck.  You just have to remember to apply it ahead of time and wrap the site in plastic.  Easier said than done if the site is not on your lower arm!  If you’re new and the stick site can be accessed easily, give it a try as you transition from Lido.  It may help.

The trick seems to be getting a tech that is really good at sticking you.  That’s not always easy.  I once asked another tech to let Krystal stick me and she got offended and walked off in a huff.  We didn’t speak for several weeks until I stopped her, apologized, and explained that I was going through a difficult sticking time and asked her not to take it personally.  We made up and were “friends” again.  But, it’s something I go through every time I have to break in a new tech.  For example, last week I was on a different shift. My regular tech wasn’t there so I had a new tech. The first time, no problem.  The next time, BIG problems.  Infiltration and bruising and tenderness.  The next time, digging and hunting and calling on the charge nurse to help.  OW!  I’m glad I’ll be back on my regular shift this next week.  But, suffice to say, no Lido.  I endured.

Again Epoman had some good advice:

Also in the future DO NOT let the tech dig around for too long if they don’t get it right away have them pull it out and try a new spot. By them digging around too much they may clog the needle with tissue and will have stick you in a new spot anyway. Believe it or not you are the boss, remember it is your arm not theirs. (Ibid)

I learned that lesson, too.  Previously, I would let the tech dig around and keep trying to find the artery or vein they so eagerly sought.  Now, I give them about 5 minutes and tell them, “Remove it!  Wait ten minutes and try again.”  I need that time to recover.  (Also, ask for Tylenol.  It helps.)  Rest up while they are getting the meds and a new needle.  In my case, there’s a spot where the vein narrows (or so we think) which makes that area particularly difficult to stick.  When a bad stick happens, I tell them to go back to proven ground and stick there.  We’ll explore new “terror-tory” later.

But long story short, no Lidocaine, no matter how much the needle stick hurts, it’s still less than the sting of the alcohol suspension of Lidocaine and there’s never enough Lido to make all the pain go away.  If you’re using Lido, I encourage you to stop.  Discuss it with your doc or an experienced tech and see what they have to say.

If you have some sage advice, please leave a comment.  Dialysis is new to many people and sharing your experience helps!

© 2012 DevonTexas

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About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I can be hooked up to a machine that will clean my blood as the kidneys should. Three days a week, I go to a center and have too very large needles stuck in my arm to remove and replace my blood as it passes through a process where it's cleaned and the fluid is removed, a process taking a little over four hours each time. I want to advance knowledge about dialysis so that other patients can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them. All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. Enjoy.
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9 Responses to Dialysis Pain and Lidocaine

  1. ovaldaze says:

    I did heamo for 9 months and I never used my fistula. I only used my permcath which was inserted into my chest. I still have my fistula, I need to have it removed at some point. But I used to watch the other patients get their needles sticks and thought there was no way I would do that. Luckily with peritineal dialysis I don’t need any needle sticks.

  2. They use Lidocaine on me when I am in the hospital. In my clinic, they use Pain Ease. it is a spray which freezes the skin. I am not sure if it is harmful to my fistula, but, it sure makes the insertion of GIANT needles easier on me!!

    • DevonTexas says:

      I’m sure the spray doesn’t have the drawbacks of Lido injection. I found these warnings about it from the manufacturer.It shouldn’t effect the fistula. But it could damage the skin and isn’t good if you have poor circulation. And, watch for infection.
      Over spraying may cause frostbite
      Freezing may alter skin pigmentation
      Use caution when using product on diabetics or persons with poor circulation
      Apply only to intact oral mucous membranes
      The thawing process may be painful and freezing may lower resistance to infection and delay healing
      If skin irritation develops, discontinue use
      PRE-INJECTION ANESTHESIA: Prepare the syringe. Swab the treatment area with an
      antiseptic. Spray the treatment area with Pain Ease continuously for 4 to 10 seconds
      from a distance of 8 to 18 cm (3 to 7 inches) until the skin just turns white. Do not frost
      the skin/area. Avoid spraying of the target area beyond this state. With the skin taut,
      quickly introduce the needle. Reapply as needed. Follow these directions for other types
      of needle insertion procedures such as starting IV’s and venipuncture.
      And I found this…
      Pain Ease causes a transient freezing of the skin surface. The anesthetic effect begins immediately after
      application, but lasts less than one minute. It should only be applied to intact skin.
      f. Exclusions:
      1.) patients with peripheral vascular conditions
      2.) patients with history of hypersensitivity to the product

  3. rick garrett says:

    I start next month and am trying to come to terms with it I HATE NEEDLES so I had the catheter installed also Im 60 years old and diabetic this is a wonderful site for me its all about staying alive and feeling well! will let you know in a couple of months on the info is true and what is not!

  4. cathy says:

    I am about to start the needles in the arm and am terrified as I hate needles. I have the script for lidocane/prilocaine cream. The above was good advice. How easy is it to stick yourselves as I do want to start the home dialysis instead of in-center. Also, has anyone heard of the self sealing hole for the needles sites?

  5. Talker says:

    I use AMLA cream. Just never liked the feel of the 14 gauge needles poking the skin.

  6. Love my Job!!! says:

    Hello all,
    You all are so brave and I admire your strength. Dialysis it not easy, just sitting in the chair for 4 hours is enough. I watch my patient do it every day. I often imagine how I would handle doing this every other day. I hate getting needles let alone 15 or 14 Gauge. I pray for your continued strength daily. I am looking for some infromation to give to one of my patients about the harmful effect of injectable lidocaine on your access. I do see that there is some guidence given above but I was looking for something more formal. Can you please assist. Thank You and Thank you for allowing me to serve you.
    Sincerely,
    Dialysis RN

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