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J-Tip and First-Attempt IV Success in Children

February 24, 2022

Written by Clay Smith

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J-Tip lidocaine infusion did not reduce first-attempt IV success and reduced pain compared to no local anesthetic in children.

Why does this matter?
Topical anesthetics, like EMLA, can help reduce pain for IV access, but they take up to 60 minutes to work, making them impractical for use in the ED. The J-Tip injects 0.25 or 0.5 mL of buffered lidocaine using pressurized CO2. I have tried it with saline, and I barely felt the injection. But does this injection of lidocaine mess up landmarks and make IV starts more difficult.

Here’s a little (J-) Tip on starting pediatric IVs…
This was an unblinded prospective cohort study comparing first attempt IV success after using a J-Tip vs no local anesthesia. There was no difference in success (87% J-tip vs 88% nothing). And pain was less in the J-Tip group, as rated by patients, parents, and nurses. A J-Tip makes a loud hiss as it infuses lidocaine via pressurized CO2, so it was not possible to blind. This could have biased all parties toward favoring the treatment arm related to pain score. But one would think it could obscure landmarks and make the IV start harder, and this would be less subject to bias. And there was no difference in this important primary outcome. Nurses had similar skill and experience in each cohort, and patient characteristics were also well matched. We still don’t know how topical agents like EMLA would compare to the J-Tip head-to-head, but such a trial would be impractical in the ED. In short, I don’t see a lot of downside in the J-Tip. In fact, we have seen increasing usage in our PED.

The Effect of Lidocaine Delivered by Jet Injection on First Attempt Venous Access Success Rates in the Pediatric Emergency Department. Pediatr Emerg Care. 2022 Jan 1;38(1):e34-e36. doi: 10.1097/PEC.0000000000002552.

What are your thoughts?