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<blockquote data-quote="Marguerite" data-source="post: 172633" data-attributes="member: 1991"><p>Barbiealonso, I hear you that some patients can't be handled any better than you already can manage. But I don't think this was one such case. I've seen good blood draws and bad blood draws; I've seen some well-managed situations and some atrociously-managed ones.</p><p></p><p>I'm well-versed in blood draws on both myself and my kids. easy child 2/difficult child 2 had to have her tonsils out and a vital requirement was a blood cross-match done beforehand. They tried to do this in the doctor's rooms but even though easy child 2/difficult child 2 was cooperating (she was 6) the doctor just couldn't get any blood. He messed around, stuck holes in her, she sat there with tears pouring down her face but she was not moving, because she knew she had to cooperate. Finally the doctor gave up and organised for a blood draw to be done at our home, from a visiting pathology nurse.</p><p>The day the nurse arrived easy child 2/difficult child 2 had been getting increasingly anxious. She was in tears before the nurse even began, so the nurse sat down next to her, showed her the needle and said, "This is a smaller needle than doctors usually use. And I'm an expert. I will do this and get it right first time, because I am really good at my job. I can't promise it won't hurt, but I can promise I'll hurt a lot less than those tonsils are hurting you."</p><p>The nurse only needed to take a few minutes but in that time she heard easy child 2/difficult child 2's fears (very real, given her experience) and reassured them. The blood draw WAS painless, easy child 2/difficult child 2 didn't even feel it. The nurse told her, "See? I TOLD you I'm good!"</p><p></p><p>And now difficult child 3, 11 years old, also heading for surgery and needing cross-match. Also cooperative, but very, very anxious. He had asked me before we went in to the pathology clinic, "Can I have a local anaesthetic?"</p><p>I said, "I don't know, but we will ask."</p><p>We asked - and the nurse was very officious, said, "Good heavens, what nonsense! It's only a simple blood draw! We don't do locals here! We haven't got time for that sort of nonsense!"</p><p>I had previously reassured difficult child 3 (remembering easy child's second, positive experience) that nurses really are good at their job, they do blood draws all day.</p><p>difficult child 3 said, "Okay then," nervously, sat in the chair - and began to feel nauseous (as he does, when his anxiety gets out of control). The nurse ignored his claim of feeling like he was about to be sick, so I grabbed a rubbish bin (couldn't see a kidney bowl anywhere). The nurse was struggling to find a vein, difficult child 3 was dry-retching into the bin, then began to faint. He was a ghastly colour and kept saying, "I'm sorry, I'm sorry..."</p><p></p><p>We got him lying down, the nurse insistent that he had to pull himself together. She had already made a few holes in one arm and although he'd been still for her, she had to give up and go for the other arm. Again, she couldn't get a drop of blood out of him - his anxiety was so high that adrenalin had closed off his superficial veins. She finally had a small needle in (she was good - she knew it was in, despite the vein being closed) and together we coached difficult child 3 to breathe slowly, in and out. On each breath out, a few more drops trickled into the tube. As he breathed in, the flow stopped.</p><p></p><p>Once the nurse had a couple of mls of blood, we still had to keep difficult child 3 lying down for a while until he could stand up again without fainting.</p><p></p><p>Remember, he WAS trying to cooperate!</p><p></p><p>He's three years older now, we make a point of having him watch when we have blood taken. A couple of times he almost fainted watching his dad have a blood draw, but he knows he has to overcome his anxiety so he really tries hard to be good.</p><p>I've had to get injections of antibiotic in my rear at times; the local nurse does it for me and difficult child 3 asked if he could watch "because I have to harden my heart to this sort of thing".</p><p></p><p>Barbiealonso, this is what you suggested, isn't it, when you said, "Noone likes going to the doctor when you go youre usually sick and miserable and they stick, poke and prode you. Take him with you to one of your visits, that is if you dont have white coat syndrome. Let him see how you handle things and then when he goes back tell him to remember that moment."</p><p></p><p>It's a really good idea if you can do this, it is what we have been trying to do, and I think it has helped a little with difficult child 3. However, our son IS 14 years old now (with 14 year sized veins too) and I do think this is also making a difference. But to have to get blood from a much smaller child - it's not easy, even for a seasoned expert. An anxious child has smaller veins that are VERY responsive to the level of adrenalin coursing through their system. Even very young easy child kids who are cooperating, can have very traumatic experiences because of their tiny veins. If the doctor or nurse is at all unsympathetic, it often only wastes more time and makes it worse for the next poor sap who has to draw blood from these kids! And all it takes for a doctor or nurse to be unsympathetic, is a busy schedule. Ironically, that's when their schedule is most likely to blow out!</p><p></p><p>It is for such kids that EMLA cream was invented.</p><p></p><p>We don't currently have any EMLA, but we have promised difficult child 3 that if he EVER has to have a blood draw done, we will INSIST on EMLA, even if we have to find a doctor to write the prescription for us. The only exception will be if the blood draw is an emergency, his life depending on haste. I suspect difficult child 3 will cope better next time, he's made amazing progress. However, we need to hear his fears and take them into account, if we're ever to have a chance of helping him overcome them. Nobody ever got over their fears by being told to "pull themselves together".</p><p></p><p>After the incident with difficult child 3 at the local pathologist (whose time got even more wasted than if she had permitted EMLA - at least with EMLA she could have put us back in the waiting room while she dealt with a few more patients while waiting for the cream to work its magic) we spoke to a friend who is also a GP. Her daughter is about the same age as difficult child 3 (and is a easy child). The doctor said to us that SHE insists on EMLA being used for her daughter - they put it on her themselves when going for a blood draw, it makes sure that there won't be any problems.</p><p></p><p>Marg</p></blockquote><p></p>
[QUOTE="Marguerite, post: 172633, member: 1991"] Barbiealonso, I hear you that some patients can't be handled any better than you already can manage. But I don't think this was one such case. I've seen good blood draws and bad blood draws; I've seen some well-managed situations and some atrociously-managed ones. I'm well-versed in blood draws on both myself and my kids. easy child 2/difficult child 2 had to have her tonsils out and a vital requirement was a blood cross-match done beforehand. They tried to do this in the doctor's rooms but even though easy child 2/difficult child 2 was cooperating (she was 6) the doctor just couldn't get any blood. He messed around, stuck holes in her, she sat there with tears pouring down her face but she was not moving, because she knew she had to cooperate. Finally the doctor gave up and organised for a blood draw to be done at our home, from a visiting pathology nurse. The day the nurse arrived easy child 2/difficult child 2 had been getting increasingly anxious. She was in tears before the nurse even began, so the nurse sat down next to her, showed her the needle and said, "This is a smaller needle than doctors usually use. And I'm an expert. I will do this and get it right first time, because I am really good at my job. I can't promise it won't hurt, but I can promise I'll hurt a lot less than those tonsils are hurting you." The nurse only needed to take a few minutes but in that time she heard easy child 2/difficult child 2's fears (very real, given her experience) and reassured them. The blood draw WAS painless, easy child 2/difficult child 2 didn't even feel it. The nurse told her, "See? I TOLD you I'm good!" And now difficult child 3, 11 years old, also heading for surgery and needing cross-match. Also cooperative, but very, very anxious. He had asked me before we went in to the pathology clinic, "Can I have a local anaesthetic?" I said, "I don't know, but we will ask." We asked - and the nurse was very officious, said, "Good heavens, what nonsense! It's only a simple blood draw! We don't do locals here! We haven't got time for that sort of nonsense!" I had previously reassured difficult child 3 (remembering easy child's second, positive experience) that nurses really are good at their job, they do blood draws all day. difficult child 3 said, "Okay then," nervously, sat in the chair - and began to feel nauseous (as he does, when his anxiety gets out of control). The nurse ignored his claim of feeling like he was about to be sick, so I grabbed a rubbish bin (couldn't see a kidney bowl anywhere). The nurse was struggling to find a vein, difficult child 3 was dry-retching into the bin, then began to faint. He was a ghastly colour and kept saying, "I'm sorry, I'm sorry..." We got him lying down, the nurse insistent that he had to pull himself together. She had already made a few holes in one arm and although he'd been still for her, she had to give up and go for the other arm. Again, she couldn't get a drop of blood out of him - his anxiety was so high that adrenalin had closed off his superficial veins. She finally had a small needle in (she was good - she knew it was in, despite the vein being closed) and together we coached difficult child 3 to breathe slowly, in and out. On each breath out, a few more drops trickled into the tube. As he breathed in, the flow stopped. Once the nurse had a couple of mls of blood, we still had to keep difficult child 3 lying down for a while until he could stand up again without fainting. Remember, he WAS trying to cooperate! He's three years older now, we make a point of having him watch when we have blood taken. A couple of times he almost fainted watching his dad have a blood draw, but he knows he has to overcome his anxiety so he really tries hard to be good. I've had to get injections of antibiotic in my rear at times; the local nurse does it for me and difficult child 3 asked if he could watch "because I have to harden my heart to this sort of thing". Barbiealonso, this is what you suggested, isn't it, when you said, "Noone likes going to the doctor when you go youre usually sick and miserable and they stick, poke and prode you. Take him with you to one of your visits, that is if you dont have white coat syndrome. Let him see how you handle things and then when he goes back tell him to remember that moment." It's a really good idea if you can do this, it is what we have been trying to do, and I think it has helped a little with difficult child 3. However, our son IS 14 years old now (with 14 year sized veins too) and I do think this is also making a difference. But to have to get blood from a much smaller child - it's not easy, even for a seasoned expert. An anxious child has smaller veins that are VERY responsive to the level of adrenalin coursing through their system. Even very young easy child kids who are cooperating, can have very traumatic experiences because of their tiny veins. If the doctor or nurse is at all unsympathetic, it often only wastes more time and makes it worse for the next poor sap who has to draw blood from these kids! And all it takes for a doctor or nurse to be unsympathetic, is a busy schedule. Ironically, that's when their schedule is most likely to blow out! It is for such kids that EMLA cream was invented. We don't currently have any EMLA, but we have promised difficult child 3 that if he EVER has to have a blood draw done, we will INSIST on EMLA, even if we have to find a doctor to write the prescription for us. The only exception will be if the blood draw is an emergency, his life depending on haste. I suspect difficult child 3 will cope better next time, he's made amazing progress. However, we need to hear his fears and take them into account, if we're ever to have a chance of helping him overcome them. Nobody ever got over their fears by being told to "pull themselves together". After the incident with difficult child 3 at the local pathologist (whose time got even more wasted than if she had permitted EMLA - at least with EMLA she could have put us back in the waiting room while she dealt with a few more patients while waiting for the cream to work its magic) we spoke to a friend who is also a GP. Her daughter is about the same age as difficult child 3 (and is a easy child). The doctor said to us that SHE insists on EMLA being used for her daughter - they put it on her themselves when going for a blood draw, it makes sure that there won't be any problems. Marg [/QUOTE]
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