Treating patients properly the first time can prevent a lifelong aversion to healthcare
by Dennis Ernst • June 07, 2019
From the Journal of American College Health--Washington. "Compassion for First Time Phlebotomy Patients," Volume 53, No. 4, Page 191-2. Reprinted with permission of the Helen Dwight Reid Educational Foundation. Published by Heldref Publications, 1319 18th Street, NW, Washington, DC 20036-1802. www.heldref.org.
Venipuncture, generally referred to as a routine laboratory procedure, is performed daily in thousands of offices, clinics, hospitals and laboratories across the world. In the United States, it has become an expected, albeit unwelcome, part of a physical exam or a quick stop at the college health center. Nurses, medical technologists, and phlebotomists generally perform the task of collecting the specific specimen required for the lab work. Phlebotomy is not as difficult as a surgical procedure or differential diagnosis, yet it is certainly a fine art and an integral part of good healthcare.
The amount of information that a health professional can gather from blood is invaluable. When coupled with the relative ease, low risk, and a small time commitment, it is easy to see why blood testing is so common. Venipuncture is a quick, moderately painless procedure that is the key to routine laboratory testing and the wealth of information it provides. The high-yield, low-cost nature of blood testing has contributed to the addition of lab testing to many, if not most, annual physicals as well as more urgent office visits.
Healthcare professionals, however, may be unaware of the anxiety some patients feel during a venipuncture experience. For many people, especially young adults, venipuncture is the first healthcare procedure they encounter that seems more traumatic than taking a pill or rubbing on a cream. On occasion, some students' desire to avoid venipuncture is viewed as cowardice. The clinician must remember that the extent of the students' experience with phlebotomy is a description of a steel needle inserted into his or her arm. Students are not being cowards, they are trying to avoid a one-inch needle being stuck into the vein in their elbow. Many times, the person doing the sticking is a complete stranger. This is not cowardice, it is common sense.
Many people associate blood tests with vaccines because both require needles in the arm and are referred to as quick sticks. Tetanus vaccines hurt. For many, tetanus is the only vaccine they remember receiving because the other routine vaccinations were administered when they were very young. The association between the unknown blood-test needle and the last needle experience---a tetanus booster---is natural and quite understandable. With that association, the pain of venipuncture is assumed to be similar. The pain is associated with the needle, not with the liquid in the syringe.
The build-up to the venipuncture procedure is much more involved than a routine vaccination. Vaccinations require that the person roll up a sleeve, and the clinician clean the skin with alcohol and puncture the skin. Phlebotomy involves rolling up the sleeve, having a tourniquet applied, palpating to locate a suitable vein, cleaning the area, applying traction to anchor the vein, and, finally, puncturing. The build-up is substantially longer and, as with any waiting period just before the event, the person's anxiety will increase.
Some may argue that people who have undergone venipuncture many times, such as those on anticoagulant regimens, view blood tests with apathy or indifference, and this is indicative of the absurdity of shying away from the phlebotomy chair. However, such people have the fortune, or misfortune, of prior experience with this exercise. First-time phlebotomy patients are nervous about the unexpected; they are scared of what has been described to them: a needle being inserted into a vein. Students are submitting to the fear of the unknown. In the university setting, they may be encountering this situation for the first time away from the comforts of their home environments.
Healthcare professionals should not look at students who are distressed about the phlebotomy experience with disdain or impatience. Instead, they must treat the student compassionately. The student may be having the test for a measles-mumps-rubella (MMR) titer, but to them, that needle is awfully intimidating. In today's environment of respect for patients and their decisions, clinicians must remember to address the unique needs of all patients, not just the sickest.
The easiest way for a provider to alleviate the student's fear is to ask whether he or she has had blood drawn before, or to answer any questions the student might have about common phlebotomy procedures. Other suggestions include having a comfortable, well-lit room and a proper phlebotomy chair for drawing blood. When verifying the student's demographic information immediately before collecting the sample, the phlebotomist should always discuss the procedure with the patient. Although the procedure is simple, these suggestions will go far in helping to calm a nervous patient, and will assist the clinician in obtaining a proper blood sample for testing.
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