Rika van de Kaa, coordinator at the pediatric infusion team, and Indra Morsing, pediatric intensivist, know the tricks of the trade. Rika: ‘Every child has their own preferences when it comes to pricking an IV or taking a blood sample. Where one child wants to see everything and count to three itself, another child wants to be distracted by the medical pedagogical care provider with a story, a jigsaw or search book. Sometimes, a child wants to watch TV or even put on a VR headset to swim along with the dolphins, as it were.’ Indra adds: ‘Many children receive a central line or PICC line at some point, so that medication can be given and blood values determined without having to bother the children. But as long as this is not the case, we as pediatric infusion team work on preventing fear of needles. We do this, among other things, by using the most experienced injection givers on our team and searching for blood vessels using painless ultrasound. If it really doesn't work, we still have nitrous oxide or sedation available.’
Ouch
‘Nobody at the Máxima Center uses the words 'pricking', 'sticking' or 'jabbing',’ says Rika. ‘These are synonymous with pain and misery, among both children and adults who come to the LATER outpatient clinic at the Máxima Center. We use neutral wording: We're going to look for blood vessels or we're going to insert a line. That prevents the negative association, because a jab means 'ouch'. We hope to prevent a fear of needles in future generations of children with cancer.’ The pediatric infusion team, consisting of anesthetists and pediatric oncology nurses, all learn ultrasound-guided needle placement. We are available for all children who are difficult to puncture or who are anxious, and we also have our own injection program at the outpatient clinic, the day treatment center or the clinic. And we have a new room, in what used to be sedation room A. Some of the children come here for a long time.’
Little trick
One regular customer is Alexander (17): ‘It's not nice to be punctured, but it's good that it can be done this way. The pediatric infusion team is important to me, because I have to be punctured very often, so it's important for them to know where it can best be done.’ He interrupts himself: ‘Watch out, because my leg goes up when they insert the needle. I tense the muscles of my right leg to distract my attention from the jab. That's my little trick.’ And before anyone notices, Rika already has the IV in his arm. This IV is for the surgery that's about to take place. Ultimately, Alexander is given a central line. ‘Until now, I didn't mind getting pricked all the time,’ he continues. ‘Every time they insert an IV, the pediatric infusion team records in my injection plan how things went. It says that I prefer to be pricked by Rika, using ultrasound, and in my left forearm. When she is free, she transfers this precise information to her colleague.’
Coffee date
Indra explains: ‘With Alexander, taking blood samples became increasingly difficult because his vessels were affected by all the medication and the many injections. In the past year, this was always recorded in the injection plan. As such, Alexander is known to the pediatric infusion team and a long-term plan has been drawn up for him. It has been decided together with the surgeons that he has a good indication for placing a central line.’ So from now on, the frequent needle placement by Rika is a thing of the past. They immediately agree to continue to see each other regularly at the Máxima Center, because Alexander, his brother Bas, his mother Monique and even his grandmother have a good relationship with her. ‘We'll just go on a coffee date from now on!’ Rika shouts to Alexander as he says goodbye.