How to Overcome IV Anxiety ‘Injection Phobia’ can be extremely difficult for patients with long term health problems, particularly in those who have conditions which involve selfadministered 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. Related: Top 5 Studying Mistakes Nursing Students Commit
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. Related: The Evolution of the Nursing Uniform 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, Education, 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 selfconfidence. 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 reframing 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’ Related: Where do Registered Nurses Work? 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. Related: International Nurses Association - What's Your Superpower? T-shirt Please follow us on Facebook, Linkedin, Pinterest and Twitter