Preparing a 5-year-old boy with hemophilia A for a joint aspiration in

an out patient context

Psychologist Frederica Cassis

Hemophilia Center of Hospital das Clínicas, SP, Brazil

Team

• Chief nurse, surgeon orthopedist, psychotherapist, Gabriel and Delcídea his mother.

• Because of his young age we believed that it was a good idea to prepare the boy

• No sedation was something new for our surgeon orthopedist

Appropriate explanations

1. Explanations from several professionals to the mother

To the mother

• Sub acute hemarthrosis which didn’t respond to factor replacement anymore

• Pain

• Joint aspiration with local anesthesia , aspiration and corticosteroid infiltration

• Local anesthesia in the upper part of the knee....

• 4 days of rest and physiotherapy

Magical and Concrete

Explanation for the kid basically all mine and the mom at home

Play therapy

Explaining the reason for the procedure: the actual joint situation with flash cards, touch and feeling of the joint

Play therapy

Starting the play therapy 4-5 sessions of 50 minutes (one month)

Showing the needle, explaining the procedure, anesthesia + infiltration

Dramatization

Breathing technique

Breathing technique to relax and deal with fear and or possible pain

The cardboard screen

The process of drawing , painting a tool that he will bring to the set of the procedure was very important

The cardboard screen

The cardboard screen

Ritual of making, preparing

Visualization : images that heal

Preparing a cardboard screen to give him the choice of hiding the sight of the procedure or watch every step.

Recovering phase

Conclusion

• From the point of view of doing the procedure in out patient context:

• The procedure was a success, no infections, no side effects of the anesthesia, rapid dispense and familiar surrounding= Lower stress

• Higher participation of the patient in the treatment, understanding of his medical situation increased his self awareness and self esteem.