Date post: | 26-Dec-2015 |
Category: |
Documents |
Upload: | neal-jordan |
View: | 228 times |
Download: | 13 times |
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
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
Developmentally appropriate care is required
Wrapping or swaddling in blanket
Pacifier
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
Comfort
PATIENT POSITIONING
Adequate support for holding (please use caution when restraining – to avoid psychological trauma)
Consider using a papoose board
Swaddling
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
Reduces patient anxiety
Increases patient/family satisfaction
Less likely to move upon initial stick
More likely to cooperate for next VAD procedure
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
Pain Control
Pain Control
Sweet Ease
Drugs: topical / systemic
Child Life
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
L-M-X4® Ethyl Chloride Lidocaine injection
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
© 2005 Gail A. Heckler, RN, BS All Rights Reserved
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