P.A.C.E.® Approved COURSE DESCRIPTION - National Center for ...

Most needle phobic patients have been told that they are “wimps” or “babies” and that
they just need to “grow up and cooperate”. They may be embarrassed about their
condition. Therefore, healthcare workers should treat these patients with empathy and
respect. A discussion of the prevalence of needle fear, the inherited nature of it, and
methods available to manage it may reassure the patient.
Positioning
Many needle phobics experience a vasovagal reflex reaction (fainting). To prevent this,
patients should lie down with their legs elevated and their heads lowered. This helps
prevent fainting and the symptoms that accompany it. As some needle phobic patients
do not faint until after the procedure, they should be encouraged to remain lying down
or sitting until they feel comfortable slowly standing up.
Topical Anesthetics
Information about minimizing procedure pain is growing, as there is increased interest
and awareness among healthcare workers. Due to this, the use of topical anesthetics
prior to IV insertion, injection, and venipuncture is increasing. Topical anesthetics have
two disadvantages: many take a long time to become effective and many only numb the
very top of the skin, allowing deeper needlesticks to be felt.
Before initiating the use of any topical anesthetic, the literature should be researched
and the manufacturer’s instructions reviewed and followed. Information on topical
anesthetics follows.
L.M.X.4®
L.M.X.4® is a non-prescription topical cream containing 4% lidocaine.
The 4% strength of lidocaine causes a loss of feeling in the skin and surrounding
tissues. As numbing occurs, a slight cooling sensation may occur.
L.M.X.4® is applied at least 30-45 minutes before the start of the procedure.
The manufacturer provides a clear plastic film to cover the cream after
application to prevent accidental ingestion or removal of the cream.
EMLA® (Eutectic Mixture of Local Anesthetics) Cream/Transdermal Patch
EMLA® is a prescription cream/transdermal patch containing 2.5% lidocaine and
2.5% prilocaine.
The cream must be covered with a clear plastic film after applied to the skin. The
transdermal patch is simply applied to the skin.
EMLA® takes at least 60 minutes to provide numbing sufficient for needle
insertion.
Pain Ease® Instant Topical Anesthetic
Pain Ease® is a skin refrigerant that provides immediate temporary numbing that
lasts up to one minute. It is applied by spraying and it can be reapplied as
needed.
Pain Ease® contains pentafluoropropane and tetrafluoroethane.
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