Sedation for blood test for teenager?

[Thisisarubbishusername]

Has anyone’s teenager been given nasal or other sedation at an NHS hospital to allow a blood test to be administered to a severely phobic teen? Our son needs blood tests but has a severe phobia of fainting during/after the procedure, after having fainted before. I’m not sure that all the CBT, distraction, preparation and other techniques he’s trying are going to be enough. Thank you.

It sounds really tough op,phobias aren't rational that's why they are bloody phobias!and it isn't always as simple as just lay down, close eyes etc. you have my sympathies and so does your poor son. Could he try some mindfulness exercises to help with his anxiety around fainting ? I'm sorry I really don't have any helpful suggestions just oodles of sympathy x

I would also add, use emla cream. My adult friend who used to faint at blood tests uses it and has never fainted since.

@CalmGreenEagle thank you for your reply. Very thoughtful and clear. X

@Sweetiedarling7 we have some emla 😊

@sarahbear87 thank you, much appreciated. Might do some mindfulness with him. X

If the problem is loss of control how the heck is sedation going to fix the problem?!

Another for tough love approach.
DD who was 8ish needed bloods doing we messed about for months and still no bloods. Eventally her dad took her and held her down while the blood was taken it was the only way.
Now she older 19 she will have her bloods done but only if dad goes with her.

I have to have regular blood tests and still faint quite a bit of the time, so I feel for your son.

It’s difficult at 14, but I’ve just accepted that it might happen, it’s not a nice feeling but I get over it soon enough. It really helps me if people around are matter of fact rather than fussing, so I do wonder whether focusing on techniques may be being a little counterproductive even though it’s clearly coming from a good place.

Experienced blood letters are definitely the key, though - and once you’ve found one he can tolerate, book with them again if possible.

My son is autistic and was terrified of blood tests, he still struggles. However, at 12 he was diagnosed with a serious chronic condition which means he has to have very regular blood tests, cannulas, and other treatments. His Great Ormond Street nurses struggled with getting blood from him because of low blood pressure and he has to have the vascular access team do it.

The only things that have got him through are:

1. Knowing that he has to have it done.
2. Numbing cream applied at home beforehand.
3. Not talking about what the phlebotomist is doing.
4. A Where's Wally book to block the view and keep his mind occupied.
5. Reminding himself that the cream does work and he feels nothing.
6. Moving to the adult phlebotomy clinic - they are far quicker, there's no waiting, and they don't make any fuss.

The first time he had to have a blood test was the same day that he underwent emergency jaw surgery. When the chips are down they can do it.

Our job as parents is to validate their feelings, but also to show confidence that they can do these things. Be factual, breezy, and kind. But truly the only way to get over this is to do it.

Also there are physical techniques you can do to combat vasovagal syncope using muscle tensing and eating some salty food beforehand can help. I once treated a girl who desperately wanted contact lenses but had tried 3 separate times and fainted every time. She just couldn't touch her eyes. We did 6 weeks of graded exposure (watching people put contacts in, touching contact lenses , looking at pictures of eyes, touching her eye, etc) and practiced the muscle tensing and she did it on her next attempt.

https://www.immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20(PDFs)/COVID-19/fainting-muscle-%20tension-resource-AODA-compliant-e.pdf

My son's next challenge is to do a blood test and then a cannula without the numbing cream. If I gave him lots of reinforcement of his fears around this he never do it. But the plan is to acknowledge he's scared, talk about the positives to doing it, and reinforce that I know he can do it.

Good luck.

@time4anothername I like your suggestion about de-catastrophising fainting. Thank you

Have you tried Kalms or anything? Random but teach him hypobirth breathing. The focusing on breathing and counting the breaths might distract him enough. Get him to lie down and tell him he can lie there afterwards until he’s confident he won’t faint. It’s hard work trying to convince your mind if something it’s so sure of. Hope he manages to overcome it.

@Thisisarubbishusername This is clearly a very complex situation and your son's feelings are very powerful and not about the pain as such, but I wonder if Emla dumbing cream might help as a sort of barrier between him and the whole process? Have you tried it?

Also, I would say that having the blood test done on an out-patient ward by a nurse (or doctor) is not the ideal day forward. They may not do bloods very often and therefore not have great technique or confidence. The best place, always, is the phlebotomy service, where the staff do nothing but take bloods all day long. They are amazing.

@RedToothBrush not sure tbh. I’m clutching at straws after a recent appt.

I used to be one of those fainters after bloods. But I was afraid of the needles.

Not used for the same thing but I used drops from Holland and Barratt for driving test to calm my nerves. Could this help calm the fear of fainting.
Our hospital has peadiatric nurses that do bloods on certain days. They were so good and quick.

@Mydonkeyisred thanks for sharing . I won’t agree to restraint I’m afraid but glad it worked for your daughter, and that she seems to handle the situation better now x

I used to faint with blood tests as a teenager. Completely understand why he's scared as it's the most horrible feeling. I would insist he has the test done lying down (face down any nurses who say "oh you'll be fine" and try and make him do it sitting up). Get him to close his eyes if looking at the cannula/vials makes him feel worse. And then make sure he sits up very slowly when it's over and his blood sugar is not too low (unless he has to have fasting bloods done). The staff may find this a minor hassle, but nothing compared to the delays and extra staff needed if he actually faints!! (Been there done that).

I eventually overcame it and can now manage blood tests in a normal position, but this was only after 3 pregnancies kind of inured me to them!

Just use the Elma numbing cream it works a treat

Have they offered you/him numbing cream? My daughter was 2½ when she was diagnosed with leukemia.......many cannulas in the early days. One thing that sometimes helped was numbing cream and then not being able to see her arm whilst someone was constantly holding it.....bit difficult to explain. The tricky thing is kids they are unpredictable! He may not be able to tolerate the not seeing what people are doing either. You sound like a caring and compassionate mum.....he needs medical trauma like a hole in the head.

@Quitelikeit I’m sure that’s very effective where pain is the fear. I don’t think it’s as simple as that with a phobia of fainting specifically around needles. But thank you.

Oh, and another thing - I am still very firm with phlebotomists that they must chat away to me about something else as a distraction and not about what they are doing to me. They are usually happy to chat about holiday plans and suchlike :-)

This ^

I also support lots of PPs suggesting diazepam. Make sure it's one the night before and one on the day. (assuming that's OK for 14 yeard olds.) Plus asking for the best nurse they have for this. (I do this for smears.)

So much this.

The worst I had was one who insisted on commenting about the (lack of) progress of the blood into the tube

Really really tough op. As a paeds nurse of over 20 years I have seen lots of kids and teens and even some parents with needle phobias or fainting - my own son faints near blood and my nephew has vasovagal syncope so needs to lie down when getting vaccines or bloods. It’s not uncommon. I’m really surprised at the comments telling him to toughen up etc.

Phobias don’t work like that. The only thing you can do is speak to his medical team, only then you will know what is available and what is not. Have you tried something like rescue remedy? I’ve used it for stressful stuff an my niece also uses it. Can make you very relaxed. A good nurse and staff will make things easier is he getting bloods in hospital or in gp surgery? Would he be open to lying down and you could talk to him - get him to watch a video or chat about soothing really interesting you’re planning - there’s also the bribery an even if he does faint if he’s safe comfortable and comes round with you holding his hand it’s not as scary as falling off a chair banging head etc (my nephew) my poor sister thought he was having a seizure. Talk to the nurses and drs who will hopefully have some ideas how to proceed and what’s available for him. He’s not the only kid/teen to go through this. My own son is asthmatic also asd and he won’t let medical people near him. Thankfully the only time he’s needed bloods/cannula he was so out of it unwell he didn’t have it in him to protest but we’ve had some awful admissions with him, it’s tough!!!

@AxolotlEars I’m sorry to hear about your daughter’s leukaemia and hope she’s doing ok at the moment. Thank you for your reply. X

I don’t think an nhs phlebotomist would sedate, would need to go private for that as it’s costly and risky. I have to have tons of blood tests so just get on with it now but in the past being super hydrated, lying down, looking at something on the wall like a poster or info sheet and wiggling my toes has helped! It’s not a nice feeling. For me it’s the tourniquet that freaks me out, not the needle. Mauve explain that sedating him is way worse than the blood tests?