Childhood Cancer

Most children’s hospitals have teams of technicians who specialize in starting IVs and drawing blood. They are usually extremely good at their jobs. An IV technician will generally use a vein in the lower arm or hand. First, the technician puts a constricting band above the site to make the veins larger and easier to see and feel. The technician then finds the vein, cleans the area, and inserts the needle. Sometimes a needle is left in place and sometimes it is removed, leaving only a thin, plastic tube in the vein. The technician makes sure the needle (or tube) is in the proper place, then covers the site with a clear dressing, and secures it with tape. Some ways you can help are:

Keep your child calm. The body reacts to fear by constricting the blood vessels near the skin surface. The calmer the child is, the larger his veins will be. Small children are usually calmest with a parent present; teenagers may or may not desire privacy. Listening to music, visualizing a tranquil scene (mountains covered with snow, floating in a pool), or using the same technician each time helps some children.

Keep your child warm. Cold temperatures cause the surface blood vessels to constrict. Wrapping the child in a blanket and putting a hot water bottle on the arm can enlarge the veins.

Encourage your child to drink lots of fluids. Hydration increases the fluid in the veins and makes them easier to find.

Let gravity help. If your child is lying in bed, have her hang her arm over the side to increase the size of the vessels in the arm and hand.

Give your child choices. If your child has a preference, let him pick the arm for the IV. If your child is a veteran of many IVs, let her point out the best vein.

• Tell your child that it’s okay to say ouch, squeeze your hand hard, or cry. Don’t say, “It won’t hurt,” because it does.

• Stop if problems develop. The secret to treating children is to spend lots of time on preparation and very little time on procedures. If a conflict arises between your child and the technician or doctor, side with your child. It’s far better to take a time-out and regroup than to force the issue and lose your child’s trust. Children can be remarkably cooperative if doctors and parents respect their needs and listen to their wishes.

David was poked many, many times one night and the technician could not get an IV in. We told him to stop. We said, “This child is totally blue from screaming. He’s worn out.” In the morning we asked the staff for the person who never misses. They brought her in and she got it on the first try.

• Use topical anesthetics. If your child needs long-term treatments that include many IVs or blood draws, ask about EMLA®, an anesthetic cream available by prescription. EMLA® is applied to the skin, covered with an airtight bandage, and left on for an hour to anesthetize the skin and underlying tissue.

The advice for starting an IV also applies to drawing blood from the arm. Blood is usually drawn from the large vein on the inside of the elbow using a procedure similar to starting an IV, except that the needle is removed rather than left in the arm.

When my friends’ four-year-old son was very sick, they asked me to bring him a bag of gift-wrapped things. I went to the dollar store and bought a whole bunch of little gifts and wrapped each one. They were things that he could carry into the exam room. Every time the doctor did a needle poke for blood work, he was allowed to open a gift. He loved the four tiny plastic frogs.