Having blood drawn can be a stressful and painful experience for pediatric patients, whose experience can be greatly influenced by the laboratory staff, the environment, and to a lesser extent, the procedure itself. Given the intimate nature of phlebotomy, the experience can be significantly different (and more substantial) for pediatric patients, and this should translate into adopting spaces and locations for pediatric phlebotomy that feel safe, comforting, and create a positive impression.
The Influence of Phlebotomy Staff
The pediatric patient responds best when staff are engaged in their work, are well-trained, and are focused on making the patient experience a positive one. The phlebotomists should be able to adapt their approach based on the age and mood of the child. Many health care organizations employ a child life specialist who serves to counsel or advise phlebotomists (among others) on communication and other pediatric patient engagement strategies. Even lacking an official position, designating certain clinical staff who have experience working with pediatric patients as advisors can be beneficial.
It is important to include parents and guardians in the experience. They may feel stress or anxiety regarding their child’s medical situation, and/or they may have their own fears of having blood drawn and project their emotions onto the child. Regardless of whether the parents/guardians are stressed or anxious, it is helpful to inform them that research has shown that a parent’s presence lowers the pediatric patient’s stress levels and that the child does not associate the pain of the procedure with the parent.
Allaying the fear of both the child and the parent or guardian will enable smoother blood draws and improve the experience for all parties involved.
Depending on the age of the child and the tests that are ordered, the phlebotomist may deploy different techniques for the blood draw. Infants and toddlers require different types of holds and distraction techniques than older patients, so be mindful of this. It is difficult to have a completely pain free procedure, so this emphasizes the need for the phlebotomist to be competent in pediatric collections in order to increase the likelihood of success on the first draw attempt. Additional options for mitigating pain include the use of topical numbing products1 or small devices that utilize vibration and cold temperature to minimize pain.2
Ultimately, good phlebotomy requires the practitioner to simultaneously perform proper technical actions and engage with the patient as a form of encouragement and distraction. Thus, it is helpful to have a variety of distraction items and techniques in the repertoire. Common distraction techniques include blowing bubbles, use of “I Spy” picture books, digital tablets, music, silly faces and noises, or even performing magic tricks. Parents and guardians likewise can be encouraged to bring their own distraction items.
When the procedure is finished, the phlebotomist should praise the patient; certainly in the event that the patient is expected to have further blood draws. Offer a reward or prize, and feel free to provide extra incentives to this highly receptive patient population.
In addition to being clean and secure, the phlebotomy room should be bright and cheery with a variety of visible distractions. Certainly, it also must have the equipment that enables a safe and comfortable procedure with easy access to collection materials. Child life specialists can be helpful in designing these environments to achieve both objectives.
Several health systems across the country have installed pediatric phlebotomy rooms that have hidden artwork on the walls which is revealed under black light upon completion of the phlebotomy procedure.3 These dramatic transformations uniquely surprise children, and the aquatic or animal or astral displays help them forget what has just happened by replacing their fear with wonder.
Certainly, creating a positive pediatric phlebotomy experience demands some effort. It requires that, as laboratories, we move away from what is easiest for us to what is in the best interest of the patient. For a pediatric patient, today’s positive phlebotomy experience sets the stage for a positive health care experience tomorrow.
Jane M. Hermansen, MBA, MT(ASCP), is Manager of Outreach and Network Development at Mayo Clinic Laboratories in Rochester, Minnesota.
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