Topical Lidocaine Application Before Port-A-Cath Access
Yes, you can and should apply topical lidocaine to the skin before accessing a Port-A-Cath with a 22-gauge Vsurecan Safety II needle to reduce procedural pain. This practice is supported by evidence demonstrating effective pain reduction with topical anesthetics for port access in oncology patients.
Evidence Supporting Topical Anesthetic Use
Topical lidocaine preparations achieve effective anesthesia for Port-A-Cath puncture, with studies showing that both amethocaine gel (30-minute application) and lidocaine-prilocaine cream (60-minute application) provide similar pain reduction during port access in children, with mean pain scores of 2.0 versus 0.5 respectively on a 0-5 scale 1
Application timing is critical for effectiveness: lidocaine-prilocaine cream (EMLA) requires 60 minutes for adequate skin anesthesia, while newer formulations like liposomal 4% lidocaine cream (LMX4) provide anesthesia in approximately 30 minutes, and heat-activated systems can reduce this to 10-20 minutes 2
The antiseptic must be applied and allowed to dry completely before topical anesthetic placement, as chlorhexidine solutions with alcohol should be used for skin preparation and must dry according to manufacturer's recommendations 2
Recommended Application Protocol
Apply topical lidocaine to at least 2 potential port access sites over the subcutaneous reservoir to ensure successful access if the first attempt fails 2
Allow adequate contact time based on the specific formulation used: 60 minutes for EMLA, 30 minutes for liposomal lidocaine, or 10-20 minutes for heat-activated preparations 2, 1
Avoid mucous membrane contact or ingestion during application 2
Do not palpate the insertion site after antiseptic application unless aseptic technique is maintained 2
Alternative or Adjunctive Anesthetic Techniques
If immediate access is required and topical anesthetic time is insufficient, intradermal lidocaine injection can be used, which is more effective when buffered with bicarbonate, warmed before injection, and administered slowly with a 22- or 25-gauge needle 2
Dripping 1-2 mL of lidocaine onto the skin surface prior to subcutaneous injection significantly reduces procedural pain (control 16.6 ± 24.8 mm vs 12.2 ± 19.4 mm on visual analog scale, P = .03), with particular benefit for central catheter procedures 3
Contraindications and Precautions
Avoid topical lidocaine if the patient has an allergy to amide anesthetics or if there is non-intact skin over the port site 2
Use lower doses in patients <12 months old or weighing <10 kg to prevent systemic toxicity 2
For EMLA specifically, avoid use in patients with recent sulfonamide antibiotic use or congenital/idiopathic methemoglobinemia 2
Do not apply topical antibiotic ointments or creams to the port site, as they may promote fungal infections and antimicrobial resistance 2
Aseptic Technique Requirements
Maintain strict aseptic technique throughout the procedure, including hand hygiene before and after accessing the port 2
Wear sterile gloves for central catheter access after skin antiseptic application 2
Use maximal sterile barrier precautions if this is considered a central line access procedure in your institution 2
Common Pitfalls to Avoid
Do not touch the port site after antiseptic application and before needle insertion, as this breaks aseptic technique even with gloves 2
Ensure the antiseptic has completely dried before applying topical anesthetic, as moisture can interfere with both antiseptic efficacy and anesthetic absorption 2
Do not rush the anesthetic contact time – inadequate waiting periods result in insufficient anesthesia and increased procedural pain 2, 1
Avoid applying topical anesthetic too early in patients with high anxiety, as prolonged anticipation of the procedure may increase distress despite adequate anesthesia 2