Procedure: Lidocaine Administration by Medical Directive

 

Ensure that patient and health care provider safety standards are met during this procedure including:

  • Risk assessment and appropriate PPE
  • 4 Moments of Hand Hygiene
  • Procedural Safety Pause is performed
  • Two patient identification
  • Safe patient handling practices
  • Biomedical waste disposal policies

Purpose:

Lidocaine is a Group IB antiarrhythmic agent that reduces the irritability of the myocardium by decreasing repolarization (decreasing QT interval).

Administration of this drug can be performed by CCTC nursing staff who are approved in the administration of life saving drugs under medical directive.
  1. Identify life-threatening rhythm
  2. Administration
  3. Continue defibrillation
  4. Prepare infusion
  5. Notify physician
  6. Monitor for side effects
  7. Document
  8. Order requirement

PROCEDURE

 1.

Identify Life-Threatening Rhythm

The nurse identifies a life-threatening arrhythmia that would respond to lidocaine:

  • Ventricular Fibrillation (VF)
  • Pulseless Ventricular Tachycardia (VT)

Lidocaine is not on the crash carts. Amiodarone should be considered the first-line drug for VT/VF rhythms (unless long QT syndrome).

Lidocaine can terminate a re-entry ventricular arrhythmia by decreasing ventricular excitability and increasing stimulation threshold of the ventricle.

Lidocaine can be an alternative for VT/VF arrhythmias if the patient has a:

  • Known allergy to Amiodarone
  • Documented prolonged QT interval

 2.

Administration

A critical care nurse may administer 1 to 1.5 mg/kg of lidocaine IV or Intraosseus (IO) direct per medical directive. 

2 - 3 mg/kg of Lidocaine may be given via the ETT if there is no venous access.

Lidocaine acts directly on the myocardial tissues to decrease excitability in the ventricles.

 3.

Continue Defibrillation Protocol

Reassess rhythms and if VF/VT present, continue to follow defibrillation procedure. VF rarely converts without an application of direct current.

 4.

Prepare Infusion

 If treatment is successful, a medical order is required for the initiation of an infusion.

The infusion is usually ordered as lidocaine 2 gm/500ml D5W at 2 mg/min (30ml/hr).

 6.

Notify Physician

Notify the critical care physician. Further treatment may be necessary.

7.

Monitor for Side Effects

Monitor for side effects of lidocaine.

Clinical signs and symptoms of toxicity include tinnitis, perioral numbness, drowsiness, disorientation, parasthesthesias, muscle twitching and agitation.

Most severe side effects include seizures, hypotension, coma and cardiorespiratory collapse. Antidote for toxicity is the administration of intralipid. 

8.

Document

The nurse documents administration and effect of lidocaine in the EHR and cardiac arrest record.

9.

Order Requirement

The medical directive is the authority to initiate the treatment. Enter an order for the lidocaine by "medical directive". 

References:

Last Update: February 10, 2020 (KK/BM), Reviewed: January 21, 2021 (BM); Reviewed January 30, 2023