Protocol question...

[Ole_Gimp]

I suspect this is going to be one of those questions that meaningful answers are going to come from the professional nursing community. Hopefully a few folks might find this of some interest…

I've endured my hip pain for too many years and have finally started to seriously look at bilateral THR. I think I have my head around the process and selection of a surgeon to perform the procedures (although I'm still sorting through the 1500 In-plan doctors my insurance company will reimburse). So far my conversations with potential doctors focused on the surgery procedures themselves. I understand that once the cutting and stitching are over in the OR and I am wheeled out of the recovery room that I'm a nursing patient to be processed to some level of medical metrics in order to be discharged within the allotted three or four days. No problem here - every one of us has goals associated with our jobs. I know that every significant discipline has a set of standard protocols they follow in order to assure efficient and consistent patient results. But how flexible are the protocols for individual aberrations?

I have a D-E-E-P psychological hang up over needles. To remain calm and not jump out of the exam room when my annual blood work is drawn is a major mind control exercise for two minutes. I understand the surgical process and believe that working with the anesthesiologist I can get put under and the surgery can be successful accomplished. It is the coming to with an IV stuck in my arm that has me rather panicked. Understand that several years ago I unintentionally, accidentally and without thinking reached up to intercept the dentist who was working in my mouth and the force of my open handed capture fractured his forearm when he forgot about my phobia and went to inject Novocain in my mouth during a procedure.

I know the medical necessity of replacing fluids and having "access" to interject medicines during the hospital stay recovery period. My query centers on do treatment protocols exist that would permit the immediate removal of the IV tubes as soon as I wake up that would produce equally successful results (abet with potential for some incremental discomfort of the patient)?

 

[Jamie]

Welcome to the forum, Gimp. We're glad to have you join us!

Our forum nurse, Josephine, is herself the hospital right now with a brand new knee so she won't be able to provide her knowledge and expertise to your question at this time. There are a couple of nurses who post now and then and they may weigh in on your particular situation. In the meantime, here are a couple of things to consider....

Generally, nurses attend to their patients based upon orders received by the patient's doctor. So in my opinion, you need to pose your questions to potential surgeons and ask them how they might handle someone with such a severe aversion to needles. If a doctor has been around the surgical theater a while, I imagine they have come across this before. Once the surgery is complete, you aren't really just "handed off" to the nursing staff. Your surgeon will be checking on you each day (or one of his staff) and he or she will still have an active role in your care. Nurses have the ability to contact them by phone at any time also, if needed. Your care is a partnership with a team (surgeon and possibly other doctors, nursing staff, and physical and/or occupational therapy personnel) throughout the time you are in the hospital.

Normally an IV is placed during surgery prep before you are given any medication. Maybe it would be possible to give you some calming medication by mouth to make that easier....i.e., you'd be awake enough to know it's happening but the drugs make you just not care.

In my non-medical opinion, the problem I see with trying to remove the IV right after surgery is that fluids must be administered along with drugs that might be impossible to duplicate by mouth. And, even though it's a small chance, if something happened where the nurses or doctors had to react quickly in administering medication, they would have to reset an IV to do it.....not a particularly wise position for you to place yourself in.

I think the wisest course of action for you is to be immediately up front with your concerns as you go about your selection of a surgeon and learn how each would deal with your situation. Also, here is a link to a guide for selecting surgeons that helps with some other questions to ask.

Please post again and let us know how you get along. The forum has a caring and diversified group of participants that can provide whatever support you might need.

 

[JudyS]

Hi
I am a hippy and want to first tell you what a wonderfully successful surgery this is. I would hate to think you stay in pain do to your needle issue. I think i have that very same problem with my 16 year old son. So I am very interestede in how this works out for you.
I like Jamie's suggestion of being medicated before the IV is started. Then my second to that is having the anesthesiologist start the IV. In the last year or so I have become a difficult to stick person . When I tell the nurse's all but one (I have frequented the local hospital with spine problems) just leaave it for the doc. They just seem to start the IV without me even feeling it. I know that is not all that bothers you, but at least it might help.

I have never tried hypnotism, but I have a wonderful therapist who does practice it. I would give it a try for sure If i were you.
I would think for your safety, the IV should be left in. I ended up having some problems at my last hospital visit and I never in a million years would have expected that to happen.

I hope others chime in with their ideas. what have you done at the dentist that has worked??
judy

 

[UTdave]

Gimper,

First, you need an IV while you're in the hospital. Period. Remember that you signed a consent which enumerates the possible complications - heart attack, stroke, medication reaction, pulmonary embolism, etc. The really bad things are unlikely, but let me tell ya, almost all of the really bad things require prompt treatment with IV meds. There is nothing worse than walking in a room of a patient who has collapsed from a heart attack or seizure and finding they don't even have an IV. Try getting an IV in that setting! There also seem to be the gods of Murphy's Law that always make the guy who doesn't have an IV have the complication. My wife always jokes that the more pages in the "birth plan" of an expecting mother, the more likely it is she'll have a C-section.

Try to be a "routine" patient, and, hopefully, everything will be routine.

Second, there is NO NEEDLE in an IV after it is placed. A needle is used to guide a soft, plastic catheter into the vein and then the needle is withdrawn. When you awake from surgery there will be a soft plastic catheter in the vein (and one in another place ;-)

Third, many hospitals give patients pre-op pain meds (I got oxycontin). If you get these, you'll be pretty darn relaxed in 20-30 minutes (assuming you don't normally take them). The anesthesiologist can also use the world's tiniest needle to inject some lidocaine over the vein so you don't feel the IV insertion. I felt absolutely nothing with this.

 

[Judles]

Welcome Gimp! Maybe you should not only alert
Your 0S, your anesthesiologist & the nursing staff
In ADVANCE so they can record your fear/phobia on your chart like an allergy alert,,,just a thought!

 

[webbie73]

Hi,
I felt complelled to answer your post since I have a MAJOR issue with the IV. My problem is not so much a needle issue but rather I am a difficult stick.

A couple of thoughts....there is a spray that can be used to numb the area prior to inserting the needle so if you close your eyes you will not feel too much. I had them use the spray last time I needed an IV and it was so much better.

I also agree with UTdave, the IV only uses a needle to guide the IV into the vein. The IV itself is a plastic tube like thing.

Like the others have said....make sure you tell the anethesia team what your concerns are..they really do care.

Please don't put of the surgery because of something that can be worked out. Talk to the surgeon when you pick one.

Let us know what you decide and how you make out with the surgeon visit.

Kathy

 

[Ole_Gimp]

Clarification - this phobia I have relates to being hooked up to the plumbing. It does not relate specifically to a needle verses a plastic catherter, et all. I also tried to clarify I figured out getting into the OR ... its the multiple days after I get out and before I leave the hospital. And I know all the logical reasons to need an IV. Phobias just aren't logical - lol.

 

[Jamie]

Thanks for clarifying things, Gimp. Have you discussed this with any of the doctors you've talked to? Maybe they could keep you on that mild sedative during the few days you must be hooked. There are some pretty good anti-anxiety drugs out there. Have you ever tried any of them? And have you discussed your phobia with your primary doctor? I'm thinking he or she would be the one to prescribe anti-anxiety medication. My daughter takes it before any dental work because she is terrified of the whole process.

 

[HopAlong]

I hate needles too, so I look away and fantasize about the beach while they are jabbing me. It works on regular needles, IV's are a little more distracting though.

My teenage son refused blood tests for many years, until finally I found a way to get him to do it. I told him he can download as many ringtones to his cell phone as he wanted while having his blood drawn. Now he actually wanted the blood drawing to last longer!!! LOL!!! He didn't feel a thing-----he was looking at his phone the whole time.