UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Injection of Local Anesthesia
Effective Date: October, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed June, 2008 May 2009 November 2011 March, 2013
PURPOSE: To provide guidelines for the injection of local anesthesia at a UWMF Clinic.
Local anesthetic – given to a patient to numb a small area for the purposes of excision, biopsy or paring
Blanching – to become white or pale
POLICY: Clinical staff, under the direction of a provider, will utilize the following guidelines to inject a local anesthesia
for the purposes of a biopsy, excision or paring of a lesion on a UWMF patient.
SUPPLIES: Provider’s order, Patient’s record, prescribed local anesthetic, gauze
3ml syringe with 30 gauge ½ inch needle, gloves, operand skin prep (Chlorahexidine Gluconate 4%,
Chloraprep 2% in a 1.5ml wand and a 3ml wand )
Anesthetics: 1% Lidocaine with Epinephrine buffered with Sodium Bicarbonate 8.4%
or as directed by provider; other examples of anesthetics include: 1 or 2% Lidocaine w/Epinephrine
1:100,000 or (without Epinephrine),Lidocaine 2% preservative free, Mepivicaine 2%, Bupivicaine 0.25%
1. Verify provider’s order for the administration of local anesthetic.
Note: 1% Lidocaine with Epinephrine buffered with Sodium Bicarbonate 8.4% will be used unless the
provider directs otherwise.
2. Wash hands; gather equipment and anesthetic to be used.
Check the expiration date of the anesthetic and buffering agent, if used
Review the 5 rights prior to drawing up – right drug, dose, time, route, and patient
Use proper procedure of drawing up medication from a vial or ampule as indicated
3. Verify patient’s allergies; including allergies to anesthetics.
4. Introduce yourself to the patient; identifying patient by asking patient for their name and date of birth.
5. Verify and educate patient, as necessary, on the type of procedure and reason for anesthetic.
6. Make the patient comfortable and expose area for injection. Provide privacy for patient.
NOTE: Ensure that patient is sitting or lying in stable position.
Educate the patient that there may be slight burning with this type of injection.
7. Wash hands and put on disposable gloves.
8. Locate site to be injected, based on provider’s order; ensuring not to inject directly into lesion or effected area.
9. Cleanse area around injection site with operand skin prep 2% or 4%. Carefully follow the manufacturer’s directions of
use located on the package or package insert.
10. Remove needle cap with non-dominant hand, pulling it straight off.
11. Stabilize area surrounding injection site.
12. Hold syringe in dominant hand, inserting needle with bevel up, at a 10 – 15 degree angle.
13. Inject medication slowly.
14. Remove needle slowly and steadily, straight out from the site.
15. Apply gentle pressure at injection site with small, dry gauze.
16. Discard needle and syringe in sharps container.
17. Assist patient to a position of comfort.
18. Remove gloves, and dispose of them properly, then wash hands.
19. Check for blanching and numbness following the administration of the lidocaine:
Blanching – if paleness or white skin color is visible.
Numbness at the site of injection – staff will ask patient if area feels numb.
NOTE: if either of the answers to the above checks is in the negative, staff may administer additional
lidocaine, not to exceed an additional 2 ml per site.
20. Observe closely for adverse reactions to the medication.
Verbal order for procedure (if order has not placed by provider)
Name and dosage of anesthetic ordered and administered
Lot # , expiration date and manufacturer (can use .medinclinic smart phrase)
Site(s) of injection
Teaching about the injection technique
How patient tolerated procedure
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVISED BY: LaVay Morrison RN Clinical Care Educator
REVIEWED BY: Lisa Hilker, CMA, Clinic Supervisor, Department of Dermatology
Lisa Gretebeck, RN, Team Leader, Transformations Clinic
Jodie Cook, Manager Dermatology
REFERENCES: 1. Deborah C Hsu, MD, MEd, Infiltration of local anesthetics; In:UpToDate,
2. Patrick C Alguire, MD, FACP, Barbara M Mathes, MD, FACP, FAAD, Skin biopsy
techniques; In: UpToDate, Basow, DS(Ed), UpToDate, Waltham, MA, 2013
AUTHORIZED BY: Richard Welnick, MD, Medical Director, Ambulatory Clinic Operations, UWMF
Eric Berg, MD, Dermatologist, Department of Dermatology, UWMF
Department of Dermatology Date
Medical Director Date