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Local anesthesia may be used to decrease the discomfort associated with intravenous insertion. Either a 25 or 27-gauge needle with 1% or 2% plain lidocaine may be used to raise a skin wheal where the intravenous catheter insertion is planned. Subcutaneous local anesthesia is commonly provided for very anxious patients or in patients requiring a large bore intravenous catheter. Some clinicians prefer not to use local anesthesia, stating that it involves an additional injection that may be more painful than the intravenous catheter insertion and may obscure the patient’s vein. Alternatively, Ametop^TM, a local topical anesthetic can be applied for 30 – 45 minutes on the dorsum of the patient’s hand prior to insertion of the intravenous catheter.