Vascular Access Considerations Within the Pediatric Population BY: Gail A. Heckler, RN, BS © 2005...

Vascular Access Considerations Within

the Pediatric PopulationBY: Gail A. Heckler, RN, BS

© 2005 Gail A. Heckler, RN, BS All Rights Reserved

PSYCHOLOGICAL TRAUMA

EXHAUSTED VENOUS ACCESS

POOR PATIENT SATISFACTION/ PATIENT RELATIONS

POSSIBLE SURGICAL INTERVENTION?

Considerations Comfort

Pain Control

Certified Child Life SpecialistVisual DemonstrationAuditory Demonstration


Developmentally appropriate care is required

Wrapping or swaddling in blanket

Pacifier


Comfort

PATIENT POSITIONING

Adequate support for holding (please use caution when restraining – to avoid psychological trauma)

Consider using a papoose board

Swaddling


Reduces patient anxiety

Increases patient/family satisfaction

Less likely to move upon initial stick

More likely to cooperate for next VAD procedure


Pain Control

Pain Control

Sweet Ease

Drugs: topical / systemic

Child Life


L-M-X4® Ethyl Chloride Lidocaine injection



PEDIATRICS?? May be necessary to use

•Anxiolysis

•Sedation

•General Anesthesia

Certified Child Life Specialist

CALL CHILD LIFE!!! Use age appropriate techniques

Developmental StagesInfant (0-12 months)

ISSUES

Develop with sensory & motor experiences

Minimal language Extension of parents Sensitive to physical

environment Little tolerance for unmet

Needs Beginning of stranger

anxiety

FEARS

Separation from parents Disruption of routine Loss of normal

stimulation Loss of security Impaired basic trust Parents fear of medical

environment and loss of parental role

Interventions

Primary care giving Encourage visiting &

holding Incorporate routines Limit abnormal stimulation Cluster intrusive

procedures (don’t involve the parents)

Lullaby music

Offer stimulation during waking hours

Speak to child in gentle, smoothing manner

Tactile stimulation to comfort child (blanket, bear)

Provide familiar objects

Developmental StagesToddler (1-3 years)

ISSUES

Motor skills rapidly developing

Egocentric Receptive language more

advanced than expressive Assertive will Making choices,

preferences Loves rituals, concerned

with change

FEARS

Separation from parents Fear of dark & loud

noises Loss of autonomy Restriction of movement Regression, loss of newly

aquired skills

Interventions

Primary care giving Incorporate routines Involve parents Medical play Age-appropriate

activities Provide brief details

of sensory information

Minimize restraints Offer diversion

techniques Allow child to play

with equipment Observe and respond

to child's cues

Developmental StagesPreschool (3-5 years)

ISSUES

Most vulnerable to hospitalization

Rapid language development

Poor distinction between fantasy and reality

Magical thinking Poor concept of time Literal interpretation of

language

FEARS

Long separation and abandonment

Medical procedures seen as punishment

Loss of control Loss of newly acquired

skills Fear of blood Regression Fear of unknown

Interventions

Continuity of care Favorite toy/object Allow participation in one’s

care(provide choices) Reassure child is not to

blame for illness Be honest Use concrete explanations

for time

Use words familiar to child

Offer diversion during procedures

Observe and respond to child's cues

Developmental StagesSchoolage (6-12 years)

ISSUES

Want to earn recognition and be successful

Some understanding of body function/structure

Able to reason/compromise

Increased understanding of time

Separation from parents is easier

FEARS

Compromised body image

Disgrace, loss of competence

Invasion of privacy Loss of status Death and disability Hesitant to reveal fears Loss of bodily control Enforced dependence

Interventions

Allow participation in own care

Encourage verbalization of thoughts/feelings

Promote a sense of responsibility

Respect fears Explain reasons for

procedures

Use positive suggestion and soft, non-threatening language

Protect privacy Offer diversion during

procedures Observe and respond

to child's cues

Developmental StagesAdolescent (12-18 years)

ISSUES

Want/doesn’t want parents close by

Self determination Decision making Peer approval important Realistic view of death Prone to mood swings Abstract thinking Interest in sexuality

FEARS

Helplessness more threatening than illness

Loss of body image Loss of control Fear of anesthesia Loss of pear acceptance Fear of failure in school Death Denial/non-compliance

with drugs

Interventions

Allow choices & control in care

Encourage peer interaction

Respect autonomy Honest explanations Protect privacy Soft, non-threatening

words

Provide opportunities for discussion and guidance

Opportunity to write answers to questions is often easier

Observe and respond to cues and behaviors

Child Life Services Provided

Assessment

Pre-procedural teaching

Procedural Support

Assessment Process

Coping of past medical experiences Past experiences with procedures Current developmental level/age Patient’s ability to refocus attention during

procedure Ability of parents to assist with coping and

support Patient’s and parents understanding of process

Pre-Procedural Teaching

Uses developmentally appropriate hands-on teaching materials (books, med supplies)

Utilize appropriate language with child per development level

Assists patient and parents in forming plan for coping and support (relaxation, breathing, books, movies, toys)

Procedural Support

When the child life specialist accompanies the patient to the procedure, the specialist may act in any of the following roles:

Spokesperson

Coach

Support for parents

The Power of Words

Selecting Appropriate Language

* Going for a CT

The Power of Words

I will feed you now. I’m ready to help you eat your lunch

The Power of Words

What’s wrong with you? Why did you have to come to the hospital?

The Power of WordsUse of pronouns

It’s time for you to take your bath now.

I imagine it is hard for you to get so many needles.

It’s time for us to take our bath now.

We don’t like it when we have to have a shot, do we?

Words

This is the time to hold still.

Don’t move!

Words

Converse in normal conversation voice Attend to all verbal and non-verbal conversation Be responsive Use positive directions

Ask the child what he/she is feeling. Never tell them what they will feel.

Do not say “I am sorry” when doing a procedure

Use words that specifically describe certain sensations

Will it hurt?

Some children tell me it feels like a pinch, other children tell me it feels like a sting.

And, some children say they don’t feel it at all.

How do you think it will feel to your doll?

Afterwards, will you tell me how it felt to you?

“Dressing Change”

Why are they going to undress me?

Will I be naked?

Do I have to change my clothes?

“Stool Collection”

Why do they want to collect little chairs?

“Shot”

Are they mad at me?

When people get shot, they are really bad hurt.

Are they trying to hurt me?

“We will give you some dye”

To make me die?

“Flush your IV”

Flush it down the toilet?

“Put you to sleep”

Like my cat was put to sleep?

It never came back.

Soft vs. Hard Words

The medicine will burn

Cut you open, make a hole

As big as…. As long as…..

As much as…..

Some children say they feel a very warm feeling.

The doctor will make a small opening

Smaller than…….. For less time than it

takes you to…….. Less than……

Avoid telling a child what they experienced-ask

them.That was hard for you. How was that for you?

Was it the way you thought it would be?

Or harder or easier?

Is there something else we should tell people about this?

Playworks

Beyond Play

Vascular Access Considerations Within the Pediatric Population BY: Gail A. Heckler, RN, BS © 2005...

Documents

Transcript of Vascular Access Considerations Within the Pediatric Population BY: Gail A. Heckler, RN, BS © 2005...