When you are prepping a pediatric client for surgery, and you find out he is deaf, DO NOT place his IV in his hands! It is how he talks!
And when he comes out from surgery, do not tie his hands down because he is not trying to rip out his tube, he is trying to tell you he wants his mom (IN SIGN LANGUAGE).
I dont know how many times my client has come out of surgery with IV's in his hands and they are strapped down. Would anyone like an IV in their mouth and gagged coming out of surgery???
If the mother is making it known he is deaf and it would be best he didn't get an IV in his hands and his hands not be tied down after surgery as he uses them to communicate she she needs to ask why this isn't being done. She will then have the answers and some peace of mind. If she finds out his veins in other areas aren't suitable that would be an acceptable answer. That is my guess as to what is happening. She then needs to ensure he hands aren't tied down because he signs and will be asking for her.
It could be that the info is being lost between pre-op and the OR. I would speak to the surgeon and be sure he passes on this info to the OR staff or try and see if I could speak to the OR nurse directly. I think if they were aware they would comply if they could. And even if they need to put an IV in his hand if it wasn't restrained he would be able to sign and not be so scared.
If the mother is aware the IV will be in his hand or might need to be she can sign that to her son prior to surgery so he's aware and will know that when he comes out. He might be less frightened that way.
No, but you assume that they just don't care. Consider it from their point of view. They need good access. And a 5 year old with 50 surgeries is NOT going to have a lot of good veins. Their biggest priority is making sure the kid makes it through surgery. As it should be.
I've watched IV goddesses have to stick somewhere they'd rather not stick, just because it's the only good spot. Using toddlers' feet, AC in a kid who has a cast on their other arm, the hand that has the thumb they suck. I'm not saying it's great for this kid, but I'm going to trust the person there at the time with responsibility for the patient at that time.
Coming through the surgery SAFELY is the #1 priority. Hierarchy of needs. Living comes before communicating.
Every once in a while instead of assuming that another healthcare professional doesn't know what they're doing or doesn't care, perhaps we should step aside and assume they have the best interests of the patient in mind. They just don't have the same opinion of what those best interests are.
Not when communication is a basic right as a patient and thats how this child does happen to communicate.
To the OP: As a last resort would the mother consider some sort of peccs book? It's a book or computer that has the child's most used words so the need to use his hands would be less. He could have a book with words/pictures that are lamanted and velcro'd on. I work at a school with handicapped children. My classroom has most of the children that are non-verbal and thats what we use.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
for those who don't have to deal with surgeries and iv accesses,
you're coming from a very appropriate point of view, you have to deal with the end result. i would do my best to ascertain that we can avoid the hands. it is only fair.
but i stick to my original premise, no matter how much you can request it not be put in the hands, etc.,
anesthesia has the final say. they can cancel the surgery. you can ask, you can request, and they will try.
i don't understand why the child doesn't have a port...that would save everyone a hassle (of course, infection control is another issue)...
but anesthesia has the final say.
there is no "being mean." on purpose--for anyone to imply that is just ridiculous and so unprofessional. i have yet to meet a healthcare professional on my team that would incur more problems than is absolutely needed.
For those who don't have to deal with surgeries and IV accesses,
There is no "being mean." on purpose--for anyone to imply that is just ridiculous and so unprofessional. I have yet to meet a healthcare professional on MY TEAM that would incur more problems than is absolutely needed.
THE END.
I dont think that anyone has said that these people are being mean on purpose!. I started this post for knowledge about placement of IV's on Deaf clients and how important communication is. This has come down to a breakdown in communication among healthcare providers, NOT PEOPLE DOING IT TO BE MEAN. Not once have I said that it is being done because they want to be mean. I think that the main focus of this post was that his ARMS WERE RESTRAINED because of a breakdown of communication that this child is deaf and speaks with his hands.
Mom is getting a laminate board made up of pictures that are most used so that she doesnt have to be present 24/7 because an ASL interpreter isnt available.
Again, it was food for thought from a different perspective.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I dont think that anyone has said that these people are being mean on purpose!. I started this post for knowledge about placement of IV's on Deaf clients and how important communication is. This has come down to a breakdown in communication among healthcare providers, NOT PEOPLE DOING IT TO BE MEAN. Not once have I said that it is being done because they want to be mean. I think that the main focus of this post was that his ARMS WERE RESTRAINED because of a breakdown of communication that this child is deaf and speaks with his hands.
Mom is getting a laminate board made up of pictures that are most used so that she doesnt have to be present 24/7 because an ASL interpreter isnt available.
Again, it was food for thought from a different perspective.
I have dealt with many peoples--special needs children, deaf, blind, mute.
As far as restraints, you have to ascertain the reason as to why this was done. I cannot tell you other than when people come out of anesthesia, they are often disoriented, and CAN become violent. In our area, we use chemical restraints first and foremost, physical restraints as a last resort...so as far as your physical ones...you have to find out why, and the REASONS.
Don't assume it's because it's just "easier." JCAHO (or whatever they are now) doesn't allow it without good reason.
As far as from your perspective, your initial OP was venting about the child and the IV/restraints. Had the parents been properly educated about it and there was proper team member communication, a lot of this might/could be alleviated. Immediate post-anesthesia care is a specialty--it is a very, very disarming situation as a parent to see a confused, screaming, biting, kicking, child. This is TYPICAL. Please educate the mom and yourself as to the PACU area.
But remember--what you request is NOT ALWAYS GOING TO BE. Reconcile that.
I have dealt with many peoples--special needs children, deaf, blind, mute.
As far as restraints, you have to ascertain the reason as to why this was done. I cannot tell you other than when people come out of anesthesia, they are often disoriented, and CAN become violent. In our area, we use chemical restraints first and foremost, physical restraints as a last resort...so as far as your physical ones...you have to find out why, and the REASONS.
Don't assume it's because it's just "easier." JCAHO (or whatever they are now) doesn't allow it without good reason.
As far as from your perspective, your initial OP was venting about the child and the IV/restraints. Had the parents been properly educated about it and there was proper team member communication, a lot of this might/could be alleviated. Immediate post-anesthesia care is a specialty--it is a very, very disarming situation as a parent to see a confused, screaming, biting, kicking, child. This is TYPICAL. Please educate the mom and yourself as to the PACU area.
But remember--what you request is NOT ALWAYS GOING TO BE. Reconcile that.
I dont know why you are taking this so personally..I know for a fact that this child is not screaming or biting because he is deaf/mute. I know that when he wakes up he is asking for his mom. The sign for this is an open hand being brought up to the chin and tapping the thumb against the chin. All he wants is his mom. I understand the use of retraints, I understand the placement of IV's, I understand the importance of COMMUNICATION, which is what this vent was about. If everything was communicated properly, quite POSSIBLY, he may have had his IV elsewhere, quite POSSIBLY he wouldnt of been restrained. THAT is what I'm venting about. Not the inadequate care that he is receiving at the hospital. The staff is highly skilled, and he does get good care there, but, one thing not being communicated leads to all of this. This was a vent to let people know this. That communication is important, and also just a view from a different perspective. That is all I was trying to do. Not headhunting PACU nurses.
if he is tapping on his chin then how is he restrained? You already posted that you are not there for his surgeries so how do you know at what point in his wake up" he is asking for his mom or that he is not kicking and biting or trying to pull out line or monitors either deliberately or accidentally? I understand communication is important but again you are not there. At some point the parent needs to be a little assertive and relay this to the team members.
I dont know why you are taking this so personally..I know for a fact that this child is not screaming or biting because he is deaf/mute. I know that when he wakes up he is asking for his mom. The sign for this is an open hand being brought up to the chin and tapping the thumb against the chin. All he wants is his mom. I understand the use of retraints, I understand the placement of IV's, I understand the importance of COMMUNICATION, which is what this vent was about. If everything was communicated properly, quite POSSIBLY, he may have had his IV elsewhere, quite POSSIBLY he wouldnt of been restrained. THAT is what I'm venting about. Not the inadequate care that he is receiving at the hospital. The staff is highly skilled, and he does get good care there, but, one thing not being communicated leads to all of this. This was a vent to let people know this. That communication is important, and also just a view from a different perspective. That is all I was trying to do. Not headhunting PACU nurses.
if he is tapping on his chin then how is he restrained? You already posted that you are not there for his surgeries so how do you know at what point in his wake up" he is asking for his mom or that he is not kicking and biting or trying to pull out line or monitors either deliberately or accidentally? I understand communication is important but again you are not there. At some point the parent needs to be a little assertive and relay this to the team members.
He is trying to do this before they restrain him. So when he wakes up and asks for mom, they think that he is trying to rip stuff off and restrain his hands..I know this because one of the nurses stated to mom what he was doing and why he was restrained, then mom states what the sign for mom is. Again it comes down to communication breakdown
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I dont know why you are taking this so personally..I know for a fact that this child is not screaming or biting because he is deaf/mute. I know that when he wakes up he is asking for his mom. The sign for this is an open hand being brought up to the chin and tapping the thumb against the chin. All he wants is his mom. I understand the use of retraints, I understand the placement of IV's, I understand the importance of COMMUNICATION, which is what this vent was about. If everything was communicated properly, quite POSSIBLY, he may have had his IV elsewhere, quite POSSIBLY he wouldnt of been restrained. THAT is what I'm venting about. Not the inadequate care that he is receiving at the hospital. The staff is highly skilled, and he does get good care there, but, one thing not being communicated leads to all of this. This was a vent to let people know this. That communication is important, and also just a view from a different perspective. That is all I was trying to do. Not headhunting PACU nurses.
There is no personalization here. It is just that you are ASSUMING that's what he is asking for. Are you there? And moreover, 50 surgeries means FIFTY DIFFERENT ANESTHESIA EXPERIENCES. YOU don't know because--ARE YOU THERE? He probably is somewhat disoriented (that is NORMAL) and you are probably correct in saying that is what he is asking for--BUT IMMEDIATE Post OP CARE is not what YOU do...so you don't understand the continuum of anesthesia and the process otherwise, this whole entire post would be moot.
WE know what to expect, and YES, guess what? We understand where you come from--our typical surgery day is 50-60 on a daily basis--so our population is extremely varied.
WE know. WE understand...This is NOT new information.
P.S. Anesthesia can make ANYONE a biter, a kicker, even a screamer (probably without the noise)...anesthesia can make the most normal of people CRAZY. If you don't know or have never seen this, then you do not understand anesthesia and I highly, highly suggest you educate yourself. That is why interfering people (healthcare providers of OTHER specialties including physicians) can and DO become impedance to care.
It is a scary experience, but a very, expected and normal one. When patients come out disoriented AND VIOLENT, We sedate them with a narcotic or even with an amnesiac--sometimes BOTH VERY QUICKLY put them back to sleep and then when they wake up--they are MOSTLY themselves.
I have seen children come out like they are demon-possessed. THEY ARE UNDER THE INFLUENCE OF ANESTHESIA and my job is to ensure that they remain safe. SAFETY IS NUMBER ONE.
When things calm down, and all is good--all systems including respiratory, cardiovascular, etc., then the communication is imperative. Otherwise the basics always, always, always precede everything else.
Please educate mom so she understands.
And PLEASE reconcile yourself to it.
This isn't personal--this is my educational retort for the day.
Batman25
686 Posts
If the mother is making it known he is deaf and it would be best he didn't get an IV in his hands and his hands not be tied down after surgery as he uses them to communicate she she needs to ask why this isn't being done. She will then have the answers and some peace of mind. If she finds out his veins in other areas aren't suitable that would be an acceptable answer. That is my guess as to what is happening. She then needs to ensure he hands aren't tied down because he signs and will be asking for her.
It could be that the info is being lost between pre-op and the OR. I would speak to the surgeon and be sure he passes on this info to the OR staff or try and see if I could speak to the OR nurse directly. I think if they were aware they would comply if they could. And even if they need to put an IV in his hand if it wasn't restrained he would be able to sign and not be so scared.
If the mother is aware the IV will be in his hand or might need to be she can sign that to her son prior to surgery so he's aware and will know that when he comes out. He might be less frightened that way.