In nursing, sticking patients with needles is a part of our job description. We have to stick patients to draw blood, start IVs, administer medications, and so forth.
And everything is fine and dandy until you come across a patient with a needle phobia. Needle phobia, also called belonephobia, aichmophobia, or trypanophobia, can come in different levels of intensity, and it’s only a matter of time until you come across a patient who has a strong fear of needles.
Needle phobia can happen to anyone and at any age, but in my experience, I’ve noticed that my male patients seem to struggle with this more often than my female patients.
For example, I was changing a man’s IV because it had expired. I successfully inserted it on the first stick, but suddenly, the patient fell back into his bed with his eyes closed. I didn’t know what had happened, so I looked at his heart monitor, and it looked fine. I checked his pulse, and it, too, was fine.
He then opened his eyes, and I asked, “Sir, are you okay?” He replied, “I’m sorry. I passed out due to my fear of needles. I probably should have let you know.”
On another occasion, I was working at the VA, and we would receive patients who had been in extreme war and combat situations—they were rough, gruff men who had killed people, shot guns, and so on. I was surprised to learn that many of them had to be placed on a gurney before being stuck with a needle!
In fact, I had one man at the VA tell me point-blank: “DO NOT let me see the needle before you stick me!”
As you can imagine, the fear of needles is a real issue that some patients experience. So, as a nurse, what are some things you can do to help your patients?
Tips for Dealing with Patients with a Needle Phobia
Gauging Your Patient’s Needle Fear
First, you’ll want to gauge (no needle pun intended) whether your patient has a fear of needles. Some patients won’t come out and tell you, fearing that they’ll appear weak. Therefore, when you tell the patient what you’ll be doing, look closely at their body language.
Do they flinch, sigh, tense up, cringe, or verbally express apprehension? If so, your patient probably has a mild-to-severe needle phobia. In this case, you’ll know that you’ll have to be extra delicate with the patient.
On the other hand, patients who don’t have a fear of needles will often appear unconcerned by the procedure, and will often say something such as, “Okay, I’m ready when you are.”
Ask the Patient if He or She Has a Preferred Needle Stick Site
Next, it can be helpful to ask the patient if they have a preferred needle stick site, when possible. Some patients will say something like this: “My right arm is always best for sticking,” whereas other patients won’t have a preference at all.
When Possible, Use the Smallest Needle Gauge Available
If a patient asks me how big the needle is going to be, I will often reassure him or her by explaining that I’m using the smallest gauge possible. This has really helped some of my patients, and if you’re not administering blood or something like that, you might be able to use a 22 or 23 gauge needle, depending on what you’re doing. (Always check your protocols.)
Educate Patients about Your Supplies
As you are setting up your supplies beside the patient (before you actually stick them), you want to take care to tell the patient that the saline flush is NOT going to be the needle. I’ve had some patients take one look at it and ask me, “Is THAT the needle?!”
I always inform the patient that “No, that isn’t the needle. It’s just the saline flush. Your needle is much smaller.”
Some patients will watch you as you set up your supplies, whereas some will prefer to look away. Just remember that the package that the needle comes in can make it look much bigger or intimidating than it actually is, so reassure the patient, if necessary.
Numbing Agents are Available
If your patient experiences severe pain (or if you’ve missed the needle stick a few times), you could use a numbing agent as an optional way to ease the pain associated with the needle stick.
Vapocoolant is one option that you could use. EMLA cream is also available, though it may take several minutes to fully numb the site, so keep that in mind.
However, it is relatively rare to administer numbing agents to the patient before sticking them, and I have only had to use that one time.
Some healthcare facilities may have protocols or standing orders in place for numbing agents, but in the case when I had to use it, I had to get a doctor’s order for it.
Distraction is Your Best Tool
When you are actually performing the needle stick, distraction is the best tool in your arsenal. Remember, the patient is mostly going to be concerned with that initial stick of the needle, and they will be anticipating that pain and building it up in their mind.
So while I am setting up my supplies and cleaning the site, I try to engage the patient in deep dialogue. The key here is not to ask silly “fluff” questions, such as “How’s the weather?”
Instead, you want to engage the patient in something that interests them or makes them think. Ask them about their career, a controversial current event, their medical history, or something that causes them to become distracted to what you are doing.
When I go to stick the patient (I never tell them when I’m going to stick them…I just do it), they rarely notice it. And when I am finished flushing the IV, the patient will often look at me and ask, “Are you finished?”
I’ll say, “Yep, I’m all done. You did great!”
Watch Your Body Language
If you do have a patient who starts crying, screaming, or passing out (as my patient did), then you want to reassure the patient. Try not to express any frustration through your body language, such as rolling your eyes, sighing, or looking away with frustration. Doing so will just make the patient feel inferior or make their phobia worse.
Instead, try to validate their feelings, and reassure them that other patients have trouble with needles and that it is a common reaction that you experience as a nurse.
Get a More Experienced Nurse to Help
Learning to stick a vein on the first try can take time and practice. I often tell new nurses that it’s perfectly normal to struggle with this skill, because it takes time to gain experience and to master the art of needle insertion.
If you’re a brand new nurse (or student) who is struggling with this skill, and you encounter a patient with a severe fear of needles, you might want to ask a more experienced nurse to help you. To sweeten the deal, you can propose an exchange by offering to do some tasks for the nurse.
I can remember being inexperienced as a new nurse, and one patient who had a fear of needles told me this: “You only get one stick, so you better get it right the first time.” I was thinking to myself, “Oh, great. I was already nervous before you told me that, and now I’m super nervous! I’m probably going to miss.”
Nevertheless, you’ll want to do the sticks yourself as time goes on, because it’s an important nursing skill that every nurse should master.
Conclusion on Dealing with Needle Phobia Patients
Needle phobia is a very real thing, and you will likely encounter it many times as a nurse. Nevertheless, there are ways you can comfort the patient and minimize their anxiety and pain.
I hope these tips helped you!