Despite this, it is inevitable that through the course of their treatment (and especially around the time of diagnosis) the child or young person and their family will have to cope with invasive procedures, such as the insertion of a peripheral cannula.
The child or young person will, whenever possible, be prepared in advance for what is to be done and what to expect. Parents/carers are encouraged to be truthful – if something is going to hurt, be honest and say that it will hurt. The child or young person with cancer will have to undergo many invasive procedures, often repeatedly, therefore we need to gain and maintain their trust. In the majority of cases this is possible and most patients seem to cope well with their treatment.
There is a range of techniques that we can employ to make painful procedures more bearable. These include play preparation, distraction, local anaesthetic, solutions to dissolve adhesive dressings and a choice of a present from the “treat box” after a procedure.
As soon as possible, all patients requiring repeated intravenous access will have a central line inserted; this reduces the need for peripheral cannula. Throughout treatment, injections are kept to an absolute minimum. Lumbar punctures and bone marrows are always performed under general anaesthetic, as is the insertion of a central venous access device. Children and young people with acute lymphoblastic leukaemia (ALL) require many lumbar punctures throughout their treatment. Some older children and young people with ALL choose to have their lumbar punctures under local anaesthetic to avoid fasting and the longer day that going to theatre entails.
Parents/carers who are well prepared and supported by staff during difficult procedures will find it easier to support their child. If the parent/carer is able to be present and supportive of their child, the patient will find it easier to cope. We encourage and assist this as these procedures have to be carried out. However, if a parent/carer does not wish to stay during a certain procedure, they must always have that choice and be reassured that staff will help their child and call them in as soon as it is finished.
Many of the treatment centres have introduced a bead trail as an extra therapeutic strategy (Beads of Courage). Every unit employs a range of the above tactics to strive to reduce the impact of invasive procedures. However, we also acknowledge that treatment for cancer is difficult and the extent to which a child or young person manages depends on their own and their family’s individual coping strategies.
Further information
Guidelines for management of distressing procedures booklet There is a small cost to buy these.
Helping your child cope with a hospital visit Information for parents from Great Ormond Street Hospital for Children