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iChoose To Perform Vascular Access Procedures with Child Life

iChoose To Perform Vascular Access Procedures with Child Life. A Nursing Perspective and Child Life Collaborative Leah Frohnerath, BS, CCLS, CEIM Stephanie Pitts, MSN, RN, CPN, VA-BC. Objectives. Identify the importance of procedural preparation and distraction for infants and children

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iChoose To Perform Vascular Access Procedures with Child Life

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  1. iChoose To Perform Vascular Access Procedures with Child Life A Nursing Perspective and Child Life Collaborative Leah Frohnerath, BS, CCLS, CEIM Stephanie Pitts, MSN, RN, CPN, VA-BC

  2. Objectives • Identify the importance of procedural preparation and distraction for infants and children • Describe the role of a Child Life Specialist and the Vascular Access Nurse • Evaluate the use of new technology in distraction including the use of iPads, Vecta, and aromatherapy • Identify how child life can collaborate with the vascular access team to improve patient outcomes • Discuss the nurses perspective on procedural pain interventions

  3. Introduction 2012 AAP Committee on Hospital Care. (2000). Child Life services. Pediatrics. 106 (5). 1156-1159. Koller, D. (2007). Preparing Children and Adolescents for Medical Procedures. Child Life Council Evidenced-Based Practice Statement. www.childlife.org

  4. “Ah Ha” Moment

  5. Define: Vascular Access Nurse Alexander, M., Corrigan, A., Gorski, L., Hankins, J. & Perucca, R. (2010). INS Infusion Nursing An Evidenced-Based Approach (3rd ed). St. Louis, MO: Saunders Elsevier

  6. Physiological Benefits ofProcedural Preparation “An extensive review of the literature along with child life clinical experience have validated that most children prepared for medical procedures experience significantly lower levels of fear and anxiety compared to children who are not prepared. Preparation also promotes long-term coping and adjustment to future medical challenges” (Child Life Council, 2007) • Lower heart rates • Remain calm and still • Improved vein quality • Procedure success more likely

  7. Benefits of Procedural Distractionon the Care Provider AAP Committee on Hospital Care. (2000). Child Life services. Pediatrics. 106 (5). 1156-1159.

  8. Vascular Assessment Dual Perspective

  9. The Child Life Specialist

  10. Common Pitfalls of CCLS • “Unrealistic” Child Life intervention plan • Unavailability • Offering to the patient things that aren’t possible • Too many choices for the child • Too much patience with the child • Lack of knowledge about the procedure • Lack of knowledge about the diagnosis or medication • Inflexibility and disregarding the RN assessment

  11. Effective Interventions for Collaboration with Nursing • Develop a personal relationship with your nurses • Available, present and engaged • Having Cell Phones instead of pagers • Check-in with them throughout the day • Develop a plan with the nurse • Circle back after the intervention and communicate • Decipher where you need to be most effective • Match your temperament to the environment • Committee Membership • As the CCLS, know when to “throw in the towel” • Go above and beyond your job description

  12. What Nursing Likes About Child Life Specialists… • Preparation • Distraction • Emotional Support of patient and family • A focus on the Child instead of the procedure • Our multi-faceted skill-set • Pain Intervention and Coping Support • Volunteer Facilitation • Normalization for the children

  13. Communication • Having open communication with your IV team is crucial! • They need to know what they are doing that works and what doesn’t work • Be specific • Be honest • Remember why you are collaborating!

  14. Integrating Child Life Ideas to the Nurse • Keep the needs of the patient at the heart of your intentions • Don’t think that the nurse will never collaborate with you • Develop your plan • Assess • Identify the challenge • EDUCATE • Re-assess • Address non-compliance

  15. The Nurses Challenge • Nurses want the patient to have the best procedural experience as possible too • Nurses often think the quicker it gets done the better • Comfort positions aren’t always comfortable… for the nurse • Some comfort positions do not provide a stable and safe position to get the procedure done • Just like anything else, working with comfort positions takes time , practice, and patience • Continue to encourage comfort positions!!!

  16. Comfort Positions

  17. Comfort Positions

  18. Comfort Positions

  19. Comfort Positions

  20. Comfort Positions

  21. Comfort Positions

  22. Comfort Positions

  23. Handbook Development • For older children/teens who prefer to understand the details of the PICC procedure • Explains and shows pictures of • Preparation • Procedural tray & equipment • The steps of the procedure • What the patient needs to do • What the PICC looks like on an arm after insertion • Photo of the portable x-ray • Photo of our team

  24. PICC Preparation Box • A box containing items related to the PICC insertion procedure • May be too overwhelming for some children • Most children are more interested in seeing and touching the catheter Photo obtained from www.angiodynamics.com

  25. iPad Chin, G. (2011, May 6). iPads Help Reduce Pain and Anxiety in the Children’s ER. National Nurses Week (May 6-12) Special: Nursing Initiative at Morgan Stanley Children’s Hospital Aims to Improve Assessment and Treatment of Pain. New York

  26. Vecta

  27. Vein Illumination

  28. Ultrasound

  29. Safe Medical Play Policy and Procedure. (2011). Medical play. St. Joseph’s Children’s Hospital of Tampa

  30. Procedural Pain Facts • Children are exposed to a large # of painful procedures • Childhood immunizations before the age of 2 years = 14-20 injections • Hospitalized infants 4-10 procedures/day • Ongoing audits report minimal or no provision of pain management • Yet good evidence supports the use of pain reducing strategies

  31. Pain Task Force Mission Statement • “The pain task force team is committed to recognizing the physical and emotional aspects of pain associated with hospitalization. We are committed to minimizing pain while providing effective and compassionate care to the children and families of our community”

  32. What can you do for…Needlestick Pain • EMLA topical 1 hour before the procedure • J-Tip • Ethyl Chloride Spray

  33. What can you do for…NG/OG insertion • Hurricaine spray to the back of the throat • Lidocaine Jelly to the tip of the tube prior to insertion

  34. What can you do for…urine catheter insertion • Lidocaine jelly to the tip of the tube prior to insertion (Urojet). • Apply to meatus 3 times 5 minutes apart for optimal results

  35. Sucrose for Painful Procedures • Most extensively studied pain intervention on infants • Goes back to 562 A.D.- prophet Mohammed-”give infants a well chewed date” • To be used for painful procedures only • Not to be used for crying & irritability • Recommended under the age of 1 year • Most effective under 2 months

  36. The Nurses Challenge

  37. Collaboration means no one interest group is always right.  It means taking what you think , what I think and what someone else thinks and coming up with something that works for everyone ~B. Crider ~

  38. Don’t Be Afraid to be Lucy.

  39. Open Discussion… & Questions

  40. Contact Us Leah Frohnerath, BS, CCLS, CEIM Child Life Specialist Leah.frohnerath@baycare.org Stephanie Pitts, MSN, RN, CPN, VA-BC Vascular Access Clinical Coordinator Stephanie.pitts@baycare.org

  41. References • Alexander, M., Corrigan, A., Gorski, L., Hankins, J., Perucca, R. (editors). (2010). Infusion Nurses Society, Infusion Nursing, An Evidenced-Based Approach (3rd ed). St. Louis, MO: Saunders Elsevier. • AAP Committee on Hospital Care. (2000). Child Life Services. Pediatrics, 106 (5). • Child Life Council. (2007). Preparing children and adolescents for medical procedures. www.childlife.org • Child Life Council. (2010). What is a child life specialist. www.childlife.org

  42. References • Chin, G. (2011, May 6). iPads Help Reduce Pain and Anxiety in the Children’s ER. National Nurses Week (May 6-12) Special: Nursing Initiative at Morgan Stanley Children’s Hospital Aims to Improve Assessment and Treatment of Pain. New York • Jameson, E., Trevana, J., & Swain, N. (2011, Jan-Feb). Electronic Gaming as Pain Distraction. Pain Research and Management. 16(1):27-32. • Karp, H. (2008). The Happiest Baby on the Block: The New Way To Calm Crying and Help Your Newborn Baby Sleep Longer.

  43. References • Koller, D. (2007). Preparing children and adolescents for medical procedures. Child Life Council. www.childlife.org • Miller K., Rodger, S., Bucolo, S. Wang, X.Q., Kimble, R.M. (2009) Multimodal Distraction to relieve Pain in Children Undergoing Acute Medical Procedures. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19951557 • Policy and Procedure. (2011). Medical play. St. Joseph’s Children’s Hospital of Tampa • Rollins, J., Bolig, R., Mahan, C. (2005). Meeting Children’s Psychosocial Needs Across the Health-Care Continuum. Austin, TX: Pro-Ed.

  44. References • Sinha M, Christopher N.C., Fenn R., Reeves L. (2006, April). Evaluation of non- pharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics, 117 (4): 1162-8. • Thompson, R. (1985). Psychosocial Research on Pediatric Hospitalization and Healthcare. Springfield, IL: Charles Thomas Publisher.

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