iChoose To Perform Vascular Access Procedures with Child Life

A Nursing Perspective and Child Life Collaborative

Leah Frohnerath, BS, CCLS, CEIMStephanie Pitts, MSN, RN, CPN, VA-BC

Objectives• Identify the importance of procedural preparation and distraction for

infants and children

• Describe the role of a Child Life Specialist and the Vascular Access Nurse

• Evaluate the use of new technology in distraction including the use of iPads, Vecta, and aromatherapy

• Identify how child life can collaborate with the vascular access team to improve patient outcomes

• Discuss the nurses perspective on procedural pain interventions

Introduction

An improved experience for

the patient

IV Team Nurse

Child LifeSpecialist

2012

AAP Committee on Hospital Care. (2000). Child Life services. Pediatrics. 106 (5). 1156-1159.Koller, D. (2007). Preparing Children and Adolescents for Medical Procedures. Child Life Council Evidenced-Based Practice Statement. www.childlife.org

“Ah Ha” Moment

Define: Vascular Access NurseSometimes referred to as “IV Team”

Role has changed over the past few years

Insertion, care & maintenance of VAD

Alexander, M., Corrigan, A., Gorski, L., Hankins, J. & Perucca, R. (2010). INS Infusion Nursing An Evidenced-Based Approach (3rd ed). St. Louis, MO: Saunders Elsevier

Physiological Benefits ofProcedural Preparation

“An extensive review of the literature along with child life clinical experience have validated that most children prepared for medical procedures experience significantly lower levels of fear and anxiety compared to children who are not prepared. Preparation also promotes long-term coping and adjustment to future medical challenges” (Child Life Council, 2007)

• Lower heart rates• Remain calm and still• Improved vein quality• Procedure success more likely

Benefits of Procedural Distractionon the Care Provider

Parent

Improve ability to support the child

Increases trust with the health care team

AAP Committee on Hospital Care. (2000). Child Life services. Pediatrics. 106 (5). 1156-1159.

Vascular Assessment Dual Perspective

Nurse Child Life Specialist

What is the diagnosis? What is the developmental level of this child?

What is the IV for? What does the child and family want and need from a Child Life Specialist?

Is the child a tough stick? What are the child’s medical experiences thus far?

How many people do I need to assist me? How can I help this child feel safe, comfortable, and trusting?

What supplies do I need? What distraction tools will be best?

The Child Life Specialist

Common Pitfalls of CCLS

• “Unrealistic” Child Life intervention plan• Unavailability• Offering to the patient things that aren’t possible• Too many choices for the child• Too much patience with the child• Lack of knowledge about the procedure• Lack of knowledge about the diagnosis or

medication• Inflexibility and disregarding the RN assessment

Effective Interventions for Collaboration with Nursing

• Develop a personal relationship with your nurses• Available, present and engaged • Having Cell Phones instead of pagers• Check-in with them throughout the day• Develop a plan with the nurse• Circle back after the intervention and communicate• Decipher where you need to be most effective• Match your temperament to the environment• Committee Membership• As the CCLS, know when to “throw in the towel”• Go above and beyond your job description

What Nursing Likes About Child Life Specialists…

• Preparation• Distraction• Emotional Support of patient and family• A focus on the Child instead of the procedure• Our multi-faceted skill-set• Pain Intervention and Coping Support• Volunteer Facilitation• Normalization for the children

Communication

• Having open communication with your IV team is crucial!

• They need to know what they are doing that works and what doesn’t work

• Be specific

• Be honest

• Remember why you are collaborating!

Integrating Child Life Ideas to the Nurse

• Keep the needs of the patient at the heart of your intentions

• Don’t think that the nurse will never collaborate with you

• Develop your plan• Assess• Identify the challenge• EDUCATE• Re-assess• Address non-compliance

The Nurses Challenge• Nurses want the patient to have the best procedural

experience as possible too

• Nurses often think the quicker it gets done the better

• Comfort positions aren’t always comfortable… for the nurse

• Some comfort positions do not provide a stable and safe position to get the procedure done

• Just like anything else, working with comfort positions takes time , practice, and patience

• Continue to encourage comfort positions!!!

Comfort Positions

Comfort Positions

Comfort Positions

Comfort Positions

Comfort Positions

Comfort Positions

Comfort Positions

Handbook Development

• For older children/teens who prefer to understand the details of the PICC procedure

• Explains and shows pictures ofPreparationProcedural tray & equipmentThe steps of the procedureWhat the patient needs to doWhat the PICC looks like on an

arm after insertionPhoto of the portable x-rayPhoto of our team

PICC Preparation Box

• A box containing items related to the PICC insertion procedure

• May be too overwhelming for some children

• Most children are more interested in seeing and touching the catheter

Photo obtained from www.angiodynamics.com

iPad

Chin, G. (2011, May 6). iPads Help Reduce Pain and Anxiety in the Children’s ER. National Nurses Week (May 6-12) Special: Nursing Initiative at Morgan Stanley Children’s Hospital Aims to Improve Assessment and Treatment of Pain. New York

Vecta

Vein Illumination

Ultrasound

Safe Medical Play

1 •Policy Development “Medical Play”•Staff Education

2 •Individual child assessment•Discuss with family at the bedside

3 •Remove rubber stopper on syringes•Proper supervision

Policy and Procedure. (2011). Medical play. St. Joseph’s Children’s Hospital of Tampa

Procedural Pain Facts• Children are exposed to a large # of painful

procedures• Childhood immunizations before the age of 2 years =

14-20 injections• Hospitalized infants 4-10 procedures/day

• Ongoing audits report minimal or no provision of pain management

• Yet good evidence supports the use of pain reducing strategies

Pain Task Force Mission Statement

“The pain task force team is committed to recognizing the physical and emotional aspects of pain

associated with hospitalization. We are committed to minimizing pain while providing effective and

compassionate care to the children and families of our community”

What can you do for…Needlestick Pain

• EMLA topical 1 hour before the procedure

• J-Tip

• Ethyl Chloride Spray

What can you do for…NG/OG insertion

• Hurricaine spray to the back of the throat

• Lidocaine Jelly to the tip of the tube prior to insertion

What can you do for…urine catheter insertion

Lidocaine jelly to the tip of the tube prior to insertion (Urojet).– Apply to meatus 3 times 5 minutes apart for optimal results

Sucrose for Painful Procedures

• Most extensively studied pain intervention on infants

• Goes back to 562 A.D.- prophet Mohammed-”give infants a well chewed date”

• To be used for painful procedures only• Not to be used for crying & irritability

• Recommended under the age of 1 year• Most effective under 2 months

The Nurses Challenge

Time

Lack of education on pain reducing strategies

Hospital culture

No physician order

Failure to document

Collaboration means no one interest group is always right. It means taking what you think , what I think and

what someone else thinks and coming up with something that works for everyone

~B. Crider ~

Don’t Be Afraid to be Lucy.

Open Discussion… & Questions

Contact Us

Leah Frohnerath, BS, CCLS, CEIM Child Life Specialist

Leah.frohnerath@baycare.org

Stephanie Pitts, MSN, RN, CPN, VA-BCVascular Access Clinical Coordinator

Stephanie.pitts@baycare.org

References• Alexander, M., Corrigan, A., Gorski, L., Hankins, J., Perucca, R. (editors). (2010). Infusion

Nurses Society, Infusion Nursing, An Evidenced-Based Approach (3rd ed). St.

Louis, MO: Saunders Elsevier.

• AAP Committee on Hospital Care. (2000). Child Life Services. Pediatrics, 106 (5).

• Child Life Council. (2007). Preparing children and adolescents for medical procedures.

www.childlife.org

• Child Life Council. (2010). What is a child life specialist. www.childlife.org

References• Chin, G. (2011, May 6). iPads Help Reduce Pain and Anxiety in the Children’s ER. National

Nurses Week (May 6-12) Special: Nursing Initiative at Morgan Stanley Children’s

Hospital Aims to Improve Assessment and Treatment of Pain. New York

• Jameson, E., Trevana, J., & Swain, N. (2011, Jan-Feb). Electronic Gaming as Pain

Distraction. Pain Research and Management. 16(1):27-32.

• Karp, H. (2008). The Happiest Baby on the Block: The New Way To Calm Crying and Help

Your Newborn Baby Sleep Longer.

References• Koller, D. (2007). Preparing children and adolescents for medical procedures. Child Life

Council. www.childlife.org

• Miller K., Rodger, S., Bucolo, S. Wang, X.Q., Kimble, R.M. (2009) Multimodal Distraction to

relieve Pain in Children Undergoing Acute Medical Procedures. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/19951557

• Policy and Procedure. (2011). Medical play. St. Joseph’s Children’s Hospital of Tampa

• Rollins, J., Bolig, R., Mahan, C. (2005). Meeting Children’s Psychosocial Needs Across the

Health-Care Continuum. Austin, TX: Pro-Ed.

References• Sinha M, Christopher N.C., Fenn R., Reeves L. (2006, April). Evaluation of non-

pharmacologic methods of pain and anxiety management for laceration repair in

the pediatric emergency department. Pediatrics, 117 (4): 1162-8.

• Thompson, R. (1985). Psychosocial Research on Pediatric Hospitalization and Healthcare.

Springfield, IL: Charles Thomas Publisher.