‘Injection Phobia’ can be extremely difficult for patients
with long term health problems, particularly in those who have conditions which
involve self-administered IV medication such as diabetes or MS.
In children, it can make minor medical appointments
challenging at best and almost impossible at worst. In severely anxious patients, it can bring
about problems with questions of consent to care, and even result in admission
if the patient has a particularly severe vasovagal response to the
administration.
So, how can we manage patients with severe IV
anxiety? Fortunately, there are a
variety of methods, some of which we will explore here.
Managing Breathing and Blood Pressure
Patients who
experience severe IV anxiety often associate it with episodes of high blood
pressure, difficulty breathing and palpitations. They may feel sick, dizzy, and/or have
ringing in their ears as a result of these symptoms. Although these responses are likely to be
benign and will not have any lasting repercussions for the patient, they are
extremely unpleasant and in some rare cases can lead to more severe issues such
as myocardial infarction.
It is estimated
that around 37% of people who report injection phobia will experience these
symptoms. Once they have been
experienced once, it is likely that they will continue to pose a barrier for
successful IV administration, so managing these symptoms successfully can make
the experience easier for you as a nurse and less harrowing for your
patient.
Studies have
shown that relaxation training is particularly successful in reducing these
symptoms in IV anxiety. Controlled
breathing techniques can help to reduce the likelihood of hyperventilation,
which will in turn help to reduce associated symptoms.
Once patients
have learned these techniques, they can slowly be introduced to different
aspects of the IV process, which will hopefully allow them to become accustomed
the different aspects of IV administration in a more relaxed manner. There is some suggestion that the feeling of
being able to control their breathing and muscles may be enough for some people
to overcome their phobia entirely, which means that further intervention will
be unnecessary.
Of course, this
approach is not suitable for acute situations - it has however shown to be
extremely beneficial in cases where patients are likely to require long term IV
medication, again such as diabetes or MS.
If hypertension
is an issue in the acute setting, it is possible that maintenance of muscle
tension may help to reduce the probability of this occurring. If the patient is well enough, a brief spurt
of physical activity (if at all possible avoiding the muscle group that the IV
is to be administered to) may help. In
severe cases of hypertension brought about by IV administration, a Beta Blocker
in a low dose may be required as a last resort.
Education
Many of the fears
that patients have about IV injection can be allayed by talking to them and
listening to their concerns.
As with many
phobias, the phobia of injections is often borne out of misinformation or
irrational fear, which would be easily eliminated by educating the patient and
providing simple information that helps to alleviate and control their fears,
whether they are real or imagined.
Teach the patient
how to prepare the injection and how to inject safely, and comfortably. Often, merely doing this alone will help to
prevent IV anxiety. Gauge your patients
understanding by asking them to repeat the instructions that you have given
them, as learning through repetition enhances confidence and retention of
information.
Encourage good
hygiene; help your patient to understand safe injection techniques and help
them to increase their levels of relaxation and self-confidence. You may find that it helps to encourage your
patient to explore different strategies for IV administration - while some
people find that sharp, fast insertion of the needle is more comfortable, some
will find that a slower pace is more suited.
It is not
uncommon to find patients who take up to 30 seconds to hit the muscle when this
technique was used on patients who needed to self-inject. Although this may seem counter-intuitive as
slower injecting usually increases pain (and is not something that you will
find being taught in any nursing schools), there is no real reason to avoid it
if it is something that helps the patient to feel in control of the
situation.
Confronting Your Patient’s Fears
Rightly or
wrongly, many patients believe that IV administration can be dangerous. Most of us, from time to time, have heard
horror stories about air bubbles causing embolisms, puncturing veins or hitting
bone, or causing various muscle disorders.
The concept of
injecting air can be particularly frightening; with many people believing that
injecting air of any volume whatsoever will cause embolism and certain
death. Some patients have reported
feeling that every time they have an injection they experience a feeling
similar to playing Russian roulette for this reason.
You may equally
find that your patient is fully aware that his or her fears are irrational and
have no basis in fact - in these patients, a technique known as cognitive re-framing may be useful.
What is Cognitive Reframing?
The definition of Cognitive reframing is as follows: Cognitive Reframing refers to the
examination of one's specific thoughts to determine whether the thoughts are
accurate or helpful in the given situation and to then modify those thoughts to
make them more accurate or useful.
In short, this is a technique that can be used to allow a
patient to recognize that their ‘autonomic reaction’ is merely a set of
symptoms rather than an indication of danger.
If their heart rate and respiration increases prior to an IV
administration, they can teach themselves to respond to it by saying ‘this is
an automatic response - I need to use relaxation techniques’
Minimizing Pain and Side Effects
This is one of
the most obvious, but most simple ways to help your patient overcome their
phobia. It is only natural for someone
to wish to avoid pain; if you patient has had repeat experiences of severe pain
during or following injections (or even if they have only experienced it once),
it can cause severe anxiety which will make all future IV’s much more
stressful, difficult and traumatic.
Given that the
tension that occurs when someone is experiencing anxiety can itself cause
increased pain, it is obvious that it is important to eliminate this as a cause
for the phobia.
Work with your
patient to find out what helps them relax - for many people, looking away will
be enough, but for others more exploration is required. Some patients may find that pacing the room
(‘psyching them up’) will help, and as stated previously this can also help
with hypertension, which is another symptom of IV anxiety.
In Summary?
Many of the most
successful techniques for alleviating IV anxiety involve education - there can
be little doubt that a patient who is in full possession of the facts around
both their condition, the requirement for IV administration and the techniques
being used will be calmer and more relaxed.
Confronting and
alleviating any fears that the patient has due to previous experience can also
be helpful - if they have had bad experiences in the past, anything that you
can do to help them understand that not all injections will be like that will
be helpful.
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