Dear Center for Phlebotomy Education:

I'm an avid believer in standards, and am implementing the new provisions of the revised venipuncture standard and need your help. I'm getting push-back from my staff about the requirement that we are not to assemble our collection devices prior to greeting the patient. We draw a lot of blood from children, and it's been established long ago to have everything ready in advance and keep devices out of sight. Assembling the equipment in front of them not only adds time, if they happen to see it it can trigger their fear. What should we do?

Our response: We disagree that it saves time. It takes only a few seconds to assemble a device, five max. If these few seconds are perceived to be critical to the success of the procedure, we think the staff is rushing things a bit much. We advocate slowing down for pediatrics, attending to their fears and anxiety, explaining the procedure, establishing rapport and trust.... All these contribute to a better, more positive experience, and certainly aren't worth the risk of a child or parent thinking a needle left behind from the last patient was used on them.

We've experienced firsthand the agony patients go through when they thought a leftover device was used on them. It's mortifying and entirely preventable.

Your staff perceives needle phobic patients don't need to see the needle. However, according to pediatric pain expert Dr. Amy Baxter, 20 percent of pediatric patients prefer to watch the procedure and do better than if they were prevented from observing. Your staff should be assessing the child's emotions in advance, and acting accordingly. One question Dr. Baxter highly recommends healthcare professionals ask pediatric patients before drawing their blood is "how do you feel about needles?" For those who express apprehension, there are ways to assemble the device without letting the child see.

Have a long conversation with your staff about pre-assembling devices, and let them air their concerns. Make sure you articulate why it's necessary to assemble the device in the presence of the patient (besides being required by the standards) and provide strategies to conceal device assembly from the view of those pediatrics they suspect to be- needle phobic.

Editor's note: Listen to our Podcast with Dr. Amy Baxter on reducing pediatric pain.

 Got a challenging phlebotomy situation or work-related question? Email us your submission at [email protected] and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)