Lidocaine cream is a topical anesthetic medication designed to numb the skin’s surface, which helps manage the discomfort associated with accessing a central venous access port. The port, often called a Port-a-Cath, is surgically placed beneath the skin to allow for repeated, reliable intravenous access for treatments like chemotherapy or blood draws. Applying this cream creates a localized lack of sensation, significantly minimizing the sharp pain experienced when a non-coring needle is inserted through the skin and into the port’s reservoir septum. This numbing effect is achieved because the medication temporarily blocks the nerve signals in the targeted area of the skin.
Essential Preparation Steps
Before dispensing the cream, a careful preparation routine helps ensure the anesthetic works effectively and safely. The first step involves confirming the prescription details, including the correct concentration of lidocaine and any specific instructions provided by the healthcare team. Gathering all necessary supplies is also important, which includes the lidocaine cream itself, a means of measuring the amount, a suitable occlusive dressing, and clean hands or disposable gloves.
Thorough hand hygiene must be performed by washing hands completely with soap and water before handling the medication or touching the port site. This prevents the transfer of bacteria to the application area. The skin directly over the port must be carefully examined to ensure it is intact and free from any cuts, rashes, or signs of irritation or infection, as the cream should not be applied to broken skin. The exact center of the port reservoir, the target for needle insertion, should be accurately located beneath the skin.
Precise Application Technique
A specific amount of cream is generally recommended by the prescribing clinician, often described as a dime-sized or quarter-sized dollop, which is typically about 1.25 cm (0.5 inch) in length from the tube. This amount must be squeezed directly onto the skin centered over the port’s reservoir.
The cream should be applied in a thick layer, creating a visible mound over the entire area where the needle will be inserted. It is important not to rub the cream into the skin, as this reduces the concentration needed for deep penetration and diminishes the numbing effect. The visible layer ensures a sufficient amount of the active ingredient remains on the surface to be absorbed into the deeper layers of the dermis.
Immediately after application, the cream must be covered with an occlusive dressing to enhance the absorption of the anesthetic into the skin. This airtight barrier, such as kitchen plastic wrap or a specialized transparent dressing, prevents the cream from drying out or being wiped away. Gauze or standard bandages should be avoided, as they will absorb the medication. The occlusive dressing should be secured with medical tape around the edges to maintain an airtight seal until removal.
Duration and Removal Protocol
The lidocaine cream requires a specific amount of time to fully penetrate the skin and produce adequate local anesthesia. The required waiting time typically ranges from 30 to 60 minutes, although some healthcare providers may recommend up to 90 minutes (1.5 hours) to ensure the deepest possible effect. Following the exact duration specified by the medical team is necessary to ensure the skin is completely numb before needle insertion.
Timing the application is necessary to align the peak numbing effect with the scheduled port access time. Patients often apply the cream at home before leaving for their appointment, accounting for travel time. If the cream is applied too early, the effect may begin to diminish, and if applied too late, the anesthetic may not have reached the necessary depth to minimize pain.
Just before the nurse or technician prepares to access the port, the occlusive dressing must be carefully removed. Any remaining cream must be completely wiped away from the skin surface. This step is important because the residue can interfere with the antiseptic skin preparation required for sterile port access. After the cream is removed, the area is cleaned with a medical-grade antiseptic, such as alcohol or chlorhexidine.
Critical Safety and Storage Information
The cream should never be applied to broken, irritated, or wounded skin, as this increases the rate and amount of absorption into the bloodstream, potentially leading to systemic toxicity. Accidental contact with the eyes, ears, nose, or mouth must be avoided, and if contact occurs, the area should be rinsed thoroughly with water immediately.
Applying too much cream, leaving it on for excessive periods, or covering a large area can lead to the absorption of a dangerous amount of the drug into the body. Signs of systemic absorption may include lightheadedness, dizziness, vision changes, or an irregular heartbeat, and immediate medical attention is required if these symptoms occur.
To maintain the medication’s effectiveness and safety, it should be stored in a closed container at room temperature, generally between 68°F and 77°F (20°C and 25°C), away from direct heat or moisture. Keep the cream out of the reach of children, as accidental ingestion or improper application can be dangerous. Any unused or expired portions of the medication should be disposed of properly according to pharmacy guidelines.