5 Myths about IV starts
5 MYTHS ABOUT IV STARTS
Needle procedures, such as blood draws and IV starts, are a necessary part of assessment and medical treatment for both children and adults. Play, medical education, role rehearsal, advocacy and coping plans are tools that child life specialists use to help children and families cope with medical procedures and hospitalization. In the medical setting, an "IV start" is a procedure that entails inserting a tube, called a catheter, into a peripheral (outer) vein such as in an arm, hand, foot or leg. To help children understand what an IV is and why they need it, a Certified Child Life Specialist uses real and toy medical equipment coupled with simple language to provide medical education and preparation. A Certified Child Life Specialist explains “an IV is a tiny, bendy tube used to give your body medicine or water that it needs,” all while demonstrating the flexibility of the tiniest catheter tube that might be attached to a lanyard around their neck for quick access. Additional education, like pointing out the "blue lines" of where the tube will go and that this is the "fastest" way for their body to get the water/medicine it needs, continue on depending on the development, temperament, interest and anxiety level of the child.
Providing this medical education in developmentally appropriate language can help children understand the why behind the need and clear up misconceptions they might have. Listed below are 5 myths about getting an IV that child life specialists often encounter, along with some comfort strategies and techniques to help a child cope when getting an IV placed.
An “IV” is a catheter (tiny, flexible tube) placed intravenously in a peripheral (arm, hand, leg, foot) vein.
Intravenous = within a vein
Myth #1: The needle stays in your arm (after the IV catheter is inserted).
Besides the fair, automatic assumption that it will hurt, this is one of the most common ones we see. It’s not just children who believe the needle remains in the arm, parents and other adult caregivers often do too. The truth is as soon as the needle and catheter are inserted into the skin, and the nurse or doctor knows it is working properly, a small button is clicked and the needle quickly retracts back into the safety lock to be discarded. The tiny, straw-like tube is all that remains under the skin to give your child’s body the water or medicine it needs. Kids often benefit from learning this method helps their body the fastest, as compared to being given by mouth. The IV is carefully secured in place with gentle, paper medical tape, clear bandages and sometimes an arm board to stay in place.
Myth #2: The poke is the hardest part of the procedure for every child.
Children commonly demonstrate highest anxiety in response to other parts of the IV placement procedure aside from the actual poke. So often the part I’ve witnessed young children having most difficult time coping with is the tourniquet being wrapped around their arm tightly. The tourniquet is a rubber band, often blue in color, that’s used to help the medical provider find a vein. It helps the veins “pop out” more, making it a critical part in an IV placement for the proper amount of blood flow for it to be successful. Since this is one of the first steps, this can set the tone for how s/he might cope for the rest of the procedure. One technique to reducing the child’s fear is to have the medical provider demonstrate on the child’s parent/guardian first. A solution to easing the discomfort of this step is to advocate for the tourniquet to go over the child’s t-shirt, gown or a wrapped paper towel around the child’s arm. This helpful remedy works across all ages! Older children and teenagers gain a sense of control and feel empowered knowing that there is a new strategy to try to help them cope. When talking with children and teens about the reason for this step, I would substitute “pop out” with “helps nurse find a vein.” I also use my own arm to point out my veins as “little green/blue lines in my body.”
Myth #3: Blocking a child’s line of sight is the best way to help them cope.
Parents, one of the most natural things we do for our children is try to protect them. It is often with knee jerk speed that a parent might put their hand up immediately to block the line of sight or even put their hand over the child’s face. What I’ve seen in my 10 years of experience is that it often escalates a child’s anxiety, especially when being forced. I’m not saying this is wrong for some children and families, but what I want to emphasize is that we all cope differently. Some of us are “information-seekers” and some of us take the “out of sight, out of mind” approach to protect ourselves and push us through these types of challenges. Giving a child the choice to watch or look away gives them a sense of control and power in a situation where they often feel powerless. And if they cry while watching, remember that this is more than okay. Crying is a form of coping. Remind the child that it is okay to watch, but their “super important job is to hold still as a statue.” If a child’s anxiety seems to keep increasing while watching, try using different distraction items as a visual shield, such as an iPad or Look and Find book, or switch to a comfort hold that makes it naturally more difficult for the child to see.
Myth #4: A child laying down is the fastest and only way to get an IV in successfully.
Research* has shown that children cope better with needle-related procedures when sitting up versus lying down. This is thought to be due to the child feeling less vulnerable and more in control when they are sitting up. Advocating for children to sit up can be one of the most important game changers when it comes to improved coping and satisfactory outcomes for the families, in my opinion and experience. I’ve had countless families share their horrible experiences at previously visited hospitals and clinics of their child immediately being held down and not given the opportunity of education, coping strategies or distraction.
Myth #5: The last IV start went horribly, so this experience won’t be any better.
The thing is, kids are extremely resilient. Do past experiences play into how one might respond in the future? Absolutely. Still, the good news is that we as parents and health care professionals have the ability to better the child’s experience the next time. Perhaps more importantly, children themselves have the power to learn and employ new coping strategies and advocate for their unique preferences (within reason) for a better experience. A key takeaway is to remember the power of positive thinking! When we believe in ourselves, we are more likely to push ourselves through challenging situations and experiences.
References:
Lacey, C. M., Finkelstein, M., & Thygeson, M. V. (2008). The impact of positioning on fear during Immunizations: Supine versus sitting up. Journal of Pediatric Nursing, 23(3), 195–200. doi: 10.1016/j.pedn.2007.09.007
Sparks, L. A., Setlik, J., & Luhman, J. (2007). Parental holding and positioning to decrease IV distress in young children: A randomized controlled trial. Journal of Pediatric Nursing, 22(6), 440-447. doi: 10.1016/j.pedn.2007.04.010