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.

Fainting (vaso vagal syncope) can be an involuntary reflex due to anxiety, as well as other causes. It’s caused by a drop in blood pressure.

I worked at NHSBT, and we encouraged our blood donors to drink extra fluids, and more importantly to squeeze and release calf and gluteal muscles during donation. This applied muscle tension technique causes the big muscle pumps in the legs to act and keep BP stable, and thus reduced the numbers of people fainting considerably. Also acts as a focus/distraction. Elevating the lower legs on a couple of pillows also helps.

The drug used in intranasal anaesthesia is midazolam (the same as used intravenously) and can cause dizziness and fainting afterwards (as well as other side effects), so I’m not sure this would be helpful if your son has a fear of fainting.

it’s a difficult situation for you, I empathise.

edited for grammar

Probably the waking up with no idea what’s happened or where you are or why you’re shaking and weak and people are staring at you. It’s horrible, fainting. I’ve been doing it since I was four years old and even the wave of the blood rushing through my ears is awful.

It’s a complete loss of control and any power to leave/fight/ensure your own safety.

Gosh you're ever so defensive.

I faint with blood tests, sometimes wee myself. Its bloody awful but I suppose the alternative is maybe being dead.

My suggestion is asking them how they would like to get through it. It's going to happen whether they like it or not but putting it in their hands may help manage the situation. No pressure needed, just a relaxed approach where they know they're being an idiot (I have suffered from anxiety for years and know I'm being an idiot). Eventually they'll get through it. Persevere!

Applied tension is one of the best techniques that has helped me. Would recommend. Especially the leg pumping or tensing and releasing the fist (not of the arm being drawn from).

Sounds tough OP. I think they use oral chloral hydrate in hospitals

Ah I feel really sorry for him. I have vasovagal syncope/faint when I get too stressed. I think a lot of posters aren't appreciating the difference in 'feeling faint' and having everything start spinning totally out of control and you collapsing in a pile, thinking you're dying as you're hitting the deck. They're not comparable. I didn't start full on fainting until my 30s and was going through a particularly challenging time. I do think a bit of tough love is needed as well as compassion though OP. It is really scary amd embarrassing but your physical health can't be ignored at the expense of your ego/emotional well being. If he faints, he faints.

Unfortunately i stopped fainting through developing a chronic health issue and now am on home injectables and regular blood tests so have just got used to them over time. I still start to faint at other things but now recognise the signs quick enough to sit on the floor before hitting the deck uncontrollably. Grounding and identifying 5 things to see, 4 to hear etc is super helpful as well.

I hope he's ok OP. Very stressful for you with both the fainting and physical health concerns that must also be going on

May I just let you know - I ''passed out'' twice - no reason or fear involved here - but I was in hospital waiting area for a long time - just sitting down and afterward my GP rang me to say I needed heart monitoring and series of pulse taken 3x a day for a few days.

I think the suggestion of decatastrophising fainting is the only good, long term option really. It sounds like it's the fear of fainting as much as the fainting itself. So they need to get to the point where they can cope with the idea that yes, they might faint, but they will be ok. That you will be there and it's nothing to be ashamed of or to fear so much.
I know that's a lot easier said than done, it took over an hour to give one of mine his flu vaccine after he completely freaked out once. Hopefully a good cbt therapist can help.

I had bad insomnia as a young teenager and they didn't give me any proper drugs but I did get beta blockers which calmed my heart rate down a little and were a good placebo, that might be an easy option if his doctor will prescribe them.

Not really an option @Thisisarubbishusername. I guess if it was life threatening they might do something or maybe he could get a Prozac ( I was given that for a colposcopy, not that it helped), but otherwise he needs to find a way to manage this for his future health.
I was severely needle phobic as a child and teenager, to the extent I had to be physically restrained to have rubella jab etc. Have fainted and scared the shit out of the phlebotomist who didn’t believe when I said I might and didn’t want me to lie down…
i still hate needles but have managed to work myself to the point where I can have vaccines and blood tests as needed. For me it is combination of:

1. rationalisation (I.e. self talk that it is vital I have this done, yes it is shit but it needs to happen and so I just need to get through it, plus I get a treat after - see below). This helps me prep myself and actually get to the appointment and also helps manage the anxiety as I have set myself up that there is no option, it just has to happen;
2. bribery- after I do the horrible, difficult thing I get a treat for being brave, whether it’s my annual greasy spoon fry up after the flu jab or whatever he likes;
3. physical prep- make sure I’ve eaten in the last 1-2 hours, something light and easy to digest and that I drink lots of water so my veins are good and as easy to draw from as possible plus I put emla cream across both arms an hour before so I know it won’t hurt; and
4. justifciation/joking- the minute I get in there I tell the practitioner I’m very sorry but im phobic and likely to cry or faint but please not to take it personally it’s no reflection on their skills! This usually gets a bit of distracting chat going plus they generally then try really hard to make it easy so you’ll tell them how great they are. I also always lie down and close my eyes while they prep and concentrate on box breathing ( breath in to count of 4, hold for 4, out for 4, hold for 4, repeat etc) and try to zone out.

It works for me and last time I didn’t even cry, so I got some extra sweets! Works for the dentist too.

I know it sounds ridiculous but it’s about building systems and routines for him to concentrate on that are predictable and controlled so he can focus on those instead of his fear.

I faint when having blood tests and it is extremely unpleasant and can be frightening so I understand the fear. Would the GP prescribe a Valium? I use Emla cream too on the injection site and that helps massively (to the point where I don’t faint when I use it).

@Ally886 yes I am defensive and have no problem owning that. I was getting a bit sick of all the tough love advocates who don’t understand vasovagal syncope, anxiety or phobias.

we have had many discussions about how he might like to get through it but as mentioned above sometimes all the planning and techies and logic goes out of the window for a person when they are panicked.

Thanks to all who have replied with some sensible suggestions to consider - a really wealth of experience and knowledge that’s been so useful. I can’t reply to each of you individually but am very grateful for some really kind messages on here.

I've had dozens and dozens of blood tests, including some fainting incidents (I have awful veins), and really do sympathise with your DS but as everyone's said, they're very unlikely to consider sedation because it's so drastic. I've also been sedated for something entirely unrelated to blood tests, and I hated the loss of control, so if that's the problem with fainting it will be an issue with sedation too.

I only ever do mine lying back now, drink lots and lots of water beforehand to encourage my veins and absolutely never look at the needle or the tube. I also go and get a mocha from the hospital Costa right afterwards. What I find is I'm far less likely to faint or feel bad if the phlebotomist is nice and quick and doesn't talk about what they're doing - what sets me off is knowing they're rootling around in there.

Also the bays they do the blood tests in at my local hospital is inevitably the same temperature as the surface of the sun. If it's the same wherever your DS is then maybe worth asking for a fan/a window?

I'd ignore the suggestions about taking him to the children's oncology ward. Aside from my own feelings on using other people's misfortune to teach your child a lesson, if you add any kind of element of guilt or shame for not being able to do it, you risk building it up even further in his mind and piling on a load of pressure when ideally they'll become routine. And I'm sure at some point he will get through this and they will get that blood!

My friend had this issue, as a teen. They took blood whilst she was safely lying on a bed in the surgery, so if she fainted, no issue of falling down or harm and they had her face away from watching and her arm was through a curtain screen, so she couldn't anticipate the needle! She grew out of the phobia, one we knew she had as she once ran out of a school queue for the Rubella vaccination and a teacher had to get her back as she fled the premises, so we knew she feared needles and she loved to tell us her medical stories.

My son was sedated for a blood test, after many failed attempts beforehand that he couldn’t cope with (due to complex needs including severe learning difficulties). This wasn’t NHS though so I couldn’t comment on whether you’d get sedation on the NHS.

It also wasn’t particularly easy - they tried oral sedation first which made him very sick, then switched to nasal and needed two doses to get him asleep enough for them to take the bloods. He was then so sleepy that he didn’t wake up until the next morning (he was staying in hospital pre-surgery).

@NursieBernard paeds endo team. They have nurses in the team who do bloods all the time and are being really great with him. He and I been chatting through some of the ideas on here this evening as there have been some great suggestions.

It might help him to know that if he really wants to… he can stop the process and leave. He is not being held against his will. He can leave and try again.

Might help him feel less like an animal being backed into a corner

I was sedated today for a procedure. He would need a cannula for sedation. I.E, a needle. Sedation is akin to passing out. I remember nothing from the procedure except the room swimming when the sedation went in.

@Ally886 good idea, and indeed he has agreed a safe word with the nurses for that purpose

@abathofmilkwithladydi hope your procedure went ok today x

I am horrified at some of the attitudes on here. Have we learnt nothing about mental health?

I can manage child birth with just gas and air, bone resetting with the same, I am fine with dental treatment and injections. I just have a real phobia of blood tests. It's crippling and devastating. I am a tough cookie but phobias aren't rational

I managed with Emla for a while but after a bad experience I now have diazepam prescribed too.

What about Emla, the numbing cream?

I'm afraid the first thing that popped into my head was kids with cancer sorry. Just reading about what some of them have to go through - if I was in that situation I'd have very little sympathy here. I'm not, thank goodness, but I can see why you've got some "tough love" responses.

Stupid question maybe but what if he doesn’t know it’s being done? I’m thinking EMLA cream, close his eyes as soon as he’s lying down, tensing and relaxing his feet/legs (helps with the fainting) and he wouldn’t know it was done until it’s over because you can’t feel it with the cream. Ask them not to say sharp scratch or anything

Hi op. My dd was the same. Thankfully we’ve come up with a plan that works for her and now she doesn’t stress about it at all.

firstly we make sure she’s going to be able to lay down to have her bloods. Then she likes to cover her face with a blanket. We don’t talk the nurse just gets straight on with it and has everything prepared beforehand. Dd knows there’s a chance she may faint or vomit (her biggest fear) so we’ve talked her through what will happen if this does occur. We have tried sedatives before but unfortunately my dd has a paradoxical reaction and they make her manic.

she did faint during a cannula placement last year. I think since the worst really did happen she’s become more relaxed about it. It wasn’t so bad. Mum was there when she came back round. She felt safe.

best of luck x