Digital Nerve Block: Best Practices and Documentation

00:01 All right. Now we're going to walk you through actually doing the procedure.

00:05 So we're going to use chlorhexidine wipe for cleaning today.

00:09 And I just want to stress that this part of the digital block itself can be aseptic technique. But depending on what you're doing, if you were doing the ring cutter you would not necessarily need sterile.

00:22 But if you're doing a nail removal, you would need sterile after this part of the procedure. So just keep that in mind when you're doing your procedure.

00:31 So you're going to break open your chlorhexidine wipe.

00:35 And you're going to wipe around the area where you're going to be doing the ring cutters. So we're going to be making sure that we're cleaning the web area here on both sides of the ring. And then you're going to discard this again.

00:47 Still keep your area clean.

00:49 So you would toss that in the garbage can.

00:51 I have drawn up just plain lidocaine for us to use today.

00:55 Again use caution if you're using with epinephrine, deciding which you want to use.

01:04 You're going to use that 25 to 27 gauge needle.

01:09 We talked about doing the dorsal aspect of the finger.

01:13 You can do that as well.

01:14 Or you can do the anterior side of the webbing of the finger.

01:19 This is the way that I was taught.

01:22 So now we're going to go in at a perpendicular angle.

01:26 So I'm going to move that out of the way. And we're going to inject.

01:32 You want to make sure that as you're pushing the needle in you're withdrawing to make sure that there's not any blood present.

01:40 If blood is present please stop and restart.

01:43 If blood is not present, you can go ahead and push forward.

01:48 You want to make sure that you're moving upward and that you're moving backward.

01:53 When you're putting in your lidocaine, make sure that you're using about 1.5 Cc's on both sides. And that's because you want the volar and the dorsal nerves to be numbed.

02:07 Again, remember when you're doing this on a patient that you want to explain that it may burn when they're receiving the lidocaine, but this is so that they will be numbed up and will not feel anything on the next part of the procedure.

02:24 Okay. So now we're going to let this sit, and we're going to let them rest for about 5 to 10 minutes. And then we're going to come back and we're going to check to see if they have any pain. So typically some tips are I would come in and do this for a patient.

02:39 And then I would step out and go see another patient and then come back in and finish the procedure. This will help you get through your day.

02:48 As with other invasive procedures, there are relevant ICD ten and CPT codes for billing which have to be documented.

02:56 Modifiers are used for specific locations.

02:59 Pick pick codes or for all your supplies.

03:02 CPT codes are primarily for your injections and your anesthetic agents, note that there is a different code if multiple digits or anesthetized, and your diagnosis codes are specific to the procedure block that was needed, as well as the anatomic location and relevance of pain codes.

03:24 Digital nerve blocks are a fundamental anesthetic technique for advanced practice nurses. It's important to remember that by gaining confidence in the skill, you are preventing much more pain, performing other skills.

03:38 Watching others with more experience and training when you get the chance is a good idea. And don't be afraid to ask questions and thank you for watching.