Really need advice re blood tests

[wantadvice]

Hi
Dd (aged 8) needs blood tests for various things and they really have to be done. I've already had to take a lot of time of work with her illness so had to arrange for my mother to take her for these in a children's hospital.
She remembers her last injection (booster one I think just before she was 5) and it was a painful experience and has often talked about disliking injections so she was nervous which I warned the nurse, who was going to do it, about.
They used the freeze spray and managed to get a little blood but for some reason the needle came out and they had to keep trying including trying the other arm. By this time of course the effects of the spray had worn off and they ended up doing a lot of prodding and getting nowhere.

Dd got more and more upset and in the end refused to have it done. Apparently she was begging them and nothing they said had an effect.

However, she really needs these tests as it could be one of a variety of quite serious things including cancer.
She is going back to hospital next week for other tests so they have said they will try and get her booked in again and maybe use gas and air.

How would gas and air work? WHat would happen? Are there any other "tricks" we can use to persuade her? She is adamant she would rather be sick then have another needle near her.
I think from the sounds of it they spent too long explaining it to her showing her the needle etc rather than distracting her adn just doing it.

I cant even get her to swallow a very small tablet now she needs to take twice a day and it cant be crushed. Any tips most welcome on this as well!!

Sorry for long post. I'm going to work soon so wont be able to reply much till later.

THanks in advance for any help.

Hi I'm really sorry that your dd
Ihad such a bad experience. I know this isn't the hospitals official policy, but I would phone the pathology lab. And ask to speak to the senior or most experienced phlebotomist. Explain your situation, and ask for their advice. In my hospital it may be that your dd could attend the adults blood taking facility, where she could have her blood taken by phlebotomists who take blood alll day every day and are highly skilled at this. The medical or support staff on a children's ward may only take 1 or 2 bloods a week (and sometimes not even that)
Just to reassure you having blood taken properly doesn't really hurt, and this is from someone who is not good with pain.
I hope your hospital can help you with this

Thanks. I did think of this. The only difficulty I might have is that as part of their persuading tactics they used going to where the adults go as a type of threat ie if you dont do it now then you'll have to go where the adults go which apparently scared her even more!

The nurse doing it wasnt fast and did have to try a few times on one arm then try the next so if someone could do it quickly it would be much better. Trouble is dd is now terrified.

I think the only way forward is for you to contact the senior phlebotomist at your hospital and ask for their advice. If you find them unsympathetic perhaps their manager or even pals.
IMO the fafffing about on a childrens ward with creams and discussions etc isn't really helpful. A good technique with one successful blood draw with little pain is much more important

So they used the freeze spray but she hadn't been offered emla cream? Another option is a quick injection of local anaesthetic, which stings a bit but works really quickly and should numb it enough for them to be able to have a really good go at getting the needle in. As others have said, I would also be asking for a very experienced person to be doing this who can get it in quickly in one go. I'm that they were showing her the needle! The key is distraction and a fast technique!

And lots of bribery ... My DS was very anxious about needles as he's seen them take blood from his mum loads since he was born - which he gets very hysterical about. We distracted with the offer of lots of bribery (brought with us to hospital for distraction) and we focused on that not the needle.
It shouldn't hurt and some people are def better than others at doing it ... I've had blood drawn monthly and even sometimes weekly for the past 12 years and I've met them all

Also try and keep her hands really warm to dilate the veins which will make it easier to find them. Cold (and unfortunately stress) will constrict them and make it harder.

Thanks for advice. I will phone the hospital to see if it's possible to get her done by specialist.

I hope things go well (especially the test results) for your dd

Thanks all.

Emla cream is fab - I have had it for DD (before she was 2yrs old) and put it on myself for her prior to an appointment - needs to be on for an hour before it will work properly though. See if they can supply this for you to use before she goes.

Hi, First of all I would def get some Emla cream for her. You need to make sure you put it on at least one hour before the blood test is due and use cold spray at the same time.
By all means try speaking to the phlebotomist but in my experience (paediatric nurse) most have little experience taking blood from children and some even refuse to do them on anyone under the age of 16.
I think it is important that you take her to a childrens blood clinic, call childrens outpatients to find out about this service. The Nurses that work there take blood from children every day and are mostly quite experienced.
If you are worried about their level of experience then ask for a peadiatric Registrar to take the blood. I appreciate that sometimes explaining the procedure, showing the needle etc can sometimes make things worse, the therory being children are simply scared of the unknown and explaining exactly what is going to happen gives them some control with no scary suprises. It is also near impossible to hold down a 8yr old so it is important to have their cooperation but if you feel this is not the best tatic with your DD have a word the nurse/dr beforehand explaining the need to just get on with it! You no your child the best and a good paediatric nurse/dr will appreciate that! HTH

Hi there, I've got a 1 year old with terrible veins who has to have bloods done every month or so. Some tips re hospitals and blood taking...Definitely agree that a children's outpatients blood clinic is the best way to go - there will be a phlebotomist who is used to taking blood from children's veins all the time. They have been much more successful than the registrars on the children's ward, where I'd end up if I couldn't get booked into the children's clinic.

You can request the Emla ('magic') cream from your GP before I believe, so that you can put this on all possible places where blood may be drawn in advance of going to hospital (it has to sit in a blob under a clear plaster for 45 mins or so).

Completely agree also with keeping hands warm, I used to have to take bloods at a clinical research place I worked at, and we had hand warmers specifically for ensuring that the blood was flowing well to the hands and thus veins were close to the surface.

Good luck with it all!

Our hospital used to have a phlebotomist that specialised in children - I don't know if you've been back yet but you could ask if they have a paediatric phlebotomist.

My DS was exactly the same, bribery worked, and one nurse told me, to get him to drink lots of fluid before the blood test, it will be easier for them to get into a vein.
It worked. I just distract him, at the time, and tell him not to look at the needle.
Good luck for your DD.

A really good treat, waved at her while they get on with it. Warm and hydrated - never go for a blood test without having a lot to drink first! I used to rub my arms a lot first too, as I've had collapsing veins and a lot of stabbing to find one, and it was not fun.

emla cream :)

There is also an alternative to emla called amitop, it's just as good so don't be put off if you get that instead. As has been mentioned, you can ask your GP for it in advance. One tip though, don't leave it on longer than the recommended time (about half an hour) as it can cause a rash if it's on longer. Either that or arrange to come to the hospital an hour early to have it put on and removed by the staff there. If she doesn't like having sticky dressings removed there is a new product which I think is called apeel which they pour on and the dressings just lift off.

If it is just a full blood count needed, or just that and a small biochemistry tube, there may also be the option to take bloods using a thumb prick rather than a cannula, it can be quite stingy but there is no needle on show to see in advance, it's just a quick stamp from an enclosed plastic device. My dd had that done once a week for over a year from the age of four and by the time she was five she didn't even cry any more. It's less traumatic if it's an option, but it depends how much blood they need.

The warm hands tip you've already had is a very good one, but also make sure she's not dehydrated on the morning, that makes it a good bit harder.

This sounds like a very scary time for you; I've been there myself and it's a horrid feeling. Hang on in there and remember it's probably not something as serious as cancer, loads of minor things share all the same symptoms, but in the unlikely event that it is, please bear in mind that there is now an 80% success rate in treating it (average figure, of course all kinds are different) and you would not be alone. I will be keeping my fingers very tightly crossed that it's something really minor and easily fixed, but my own dd just finished two years of chemo for leukaemia, so if you're worried or, god forbid, you find you're heading down that kind of path yourself, pm me at any time.