By Dr. Marty Becker
I have two elderly family members: a mother-in-law, Valdie, age 92, and a brother-in-law, Rockey, age 69, who both hate needles. No, let’s make that HATE needles. I’m not overstepping if I bold HATE. This fear of needles has caused serious health risks or consequences for both of them:
- They forgo vaccinations for the flu, a disease that if contracted can be deadly for the elderly.
- They avoid getting annual blood work required by their physicians to renew prescriptions for lifesaving drugs to control blood pressure and cholesterol. They skipped the tests and couldn’t get prescriptions refilled.
- They refused to get weekly blood tests to look at clotting times to help regulate anticoagulants to prevent cardiovascular incidents such as heart attack or strokes. As a result, platelet levels got so low that Valdie began bleeding spontaneously.
Valdie and Rockey aren’t dumb people. They know right from wrong. They aren’t ignorant of risk. Then why not buck up, man up, toughen up, roll up the sleeves, and as Larry The Cable Guy says, “Git ‘er done?” Simple answer in three words: Fear. Anxiety. Stress.
A fear of needles is the number-one most dreaded thing in human medicine. We’re not talking timidity here. Put needles in the same heart-pounding, throat-tightening, face-flushed category as spiders and snakes. If this weren’t bad enough, it can truly be doubly worse at the veterinary hospital where both the pet and pet owner can explode in a full-blown panic attack in the exam room on sight of a 22-gauge ¾-inch needle.
Several things can happen if we don’t provide pets with a more comfortable injection experience:
- We can cause the pet and the owner unnecessary fear, anxiety, and stress (FAS).
- Pets may injure themselves attempting to escape the perceived threat by jumping off a high table.
- Owners decide it’s simply not worth the hurt to the pet or the hassle to themselves to take a pet to a veterinary hospital for routine vaccinations, to get a blood test for heartworms, or to undergo cystocentesis. Put another way, pet owners don’t want to feel as if trying to help pets by getting necessary preventive care, diagnostics, and treatment is actually hurting them.
Luckily for pets, owners and the practice team, the Fear Free Advisory Group has been working hard on taking the pet out of petrified. And because needles are such a big part of veterinary medicine, we have developed protocols on how to create a more comfortable injection experience (for vaccines, sedation and anesthesia, injectable drugs, blood draws, and IV catheters). Here are the top 10 steps:
- Get a grip. Animals have an innate fear of losing their footing. I see this with horses on muddy trails, older dogs walking on tile floors, and myself braving two inches of clear ice to go up to the barn and feed the animals. When doing a procedure that involves injections, have the pet standing on a yoga mat, lying on a Pet Vet Mat or fleece blanket, or on some other nonskid surface.
- Hello, I’m here. I grew up around animals, and one of the first things you learn is to let animals know that you’re nearby. On our farm and ranch in southern Idaho, if you didn’t let the horse or dairy cow know you were going to get up close and personal, you very well might find a hoof stamped into your thigh. Use your voice, slow movements, and soft touches to let pets know you’re arriving.
- Play Hide-And-Sneak. I used to draw vaccines and prepare to vaccinate a pet as if I were on stage. What was I thinking! Neither person nor pet likes needles, and there I was flashing the instrument of torture. Now, the syringes and needles are hidden beneath a pastel-colored towel impregnated with pheromones. Nobody except the person delivering the goods sees the “weapons of ass destruction.”
- Cheap trick. I’ve owned part or all of seven veterinary hospitals over the past four decades and have been privy and partner to the bad, old, cheapskate practice of autoclaving and reusing needles and syringes. I can distinctly remember the feeling that went up my arm when a needle had a burr on it (imagine what the pet felt!) as it dragged or tore through tissue. Yikes! Now, we not only use a new syringe and needle to draw out the vaccine, but switch to a brand-new needle to inject the vaccine. We also change needles after drawing up antibiotics, sedatives, anesthetics, anything and everything really. We’re going to puncture the skin only with new needles.
- Size matters. While it can be a drag, literally and figuratively, to draw up vaccine or other medications with small-gauge needles, it’s a real pain for pets if you use a needle size that’s larger than what’s needed to deliver the injection. While we’re waiting on some research to prove which size needle produces the least discomfort, we can take direction from the millions of people who have to take daily injections of insulin. They use hair-thin, ultra-lubricated needles, as tiny as possible. For thousands of practices, 25- to 27-gauge needles are the perfect size for vaccines. Size also matters when it comes to the amount of fluid used in the vaccine. Whenever possible, choose a ½ mL vaccine, such as Elanco’s ULTRA line of vaccines, and you will notice a difference resulting in a more comfortable injection experience.
- Go “slow with the flow.” All you have to do is recall the hydraulics of water fights where you had the piston-driven lime-green, lemon-yellow, or orange water cannon. If you wanted to shoot it far or really blast somebody up close, you pushed the plunger as fast and as hard as you could. Now think of the needle and syringe full of fluid under the skin as a tiny water cannon, with the plunger being the piston. The more volume there is and the faster you give it, the faster and farther it will tear subcutaneous tissues, which results in more pain and discomfort. A benefit to using Elanco’s ULTRA vaccines is they are half the volume of a traditional 1 mL vaccine, so you are only injecting a ½ mL of liquid into the pet, resulting in a more comfortable, less invasive needle stick. While the pet is distracted with treats, give the 1 mL vaccine over three to five seconds; with the ½ mL ULTRA vaccine, you will need half the time to administer resulting in less time and more comfort!
- You’re dead to me. The local hospital where I get my cholesterol tested offers patients the option to have the skin deadened with a topical gel. Why would anyone want to feel the needle? We’re not talking a dead tongue or numb gums from a dental procedure, just a numb patch of skin. Use prilocaine/lidocaine gel early, often, and generously. While it can work great to apply a generous amount of the topical anesthetic on the places you want to insert the vaccine needle when you first start your exam (giving it time to work), you should routinely use this for blood draws and IV-catheter placement.
- Distraction techniques. The local hospital I spoke of further beats down FAS from blood draws by a) telling patients to hum happy birthday to themselves, and/or b) giving them a toy called Panic Pete that you squeeze when the needle goes in (Pete’s eyes bug out like a cartoon character when you squeeze him). While these techniques won’t work for pets, we use an even more powerful tool to distract pets’ attention from the sight of the needle or impending sting (assuming we haven’t deadened the skin). Food. Not just any food – really, REALLY tasty treats such as deli turkey, peanut butter, or spray cheese. Put EasyCheese Cheddar & Bacon on a pretzel stick or an entire Beggin Strip in front of a hungry dog’s nose and you’ll see it works like a magic wand to direct the eyes, muzzle and attention away from the bad and towards the good.
- Touch Gradient. In the bad old days of practice, I used to just pull up a fold of skin, inject, and let go. Bam! Now with Touch Gradient, I’m like a veterinary massage therapist as I touch and stroke the skin with one hand, tent the skin, touch with the other hand, tent the skin and repeat one to three times before I inject. Rather than the “Bam” of a sudden equivalent of a bee sting, I desensitize the area I’m going to prick with just my hands.
- Begin with the end in mind. Once the deed is done – as in the catheter placed, blood drawn, vaccines given – don’t stop there! You don’t want to end with a negative, quite the opposite. At Fear Free hospitals, we finish off the procedure with the absolute tastiest morsel of food imaginable. Favorites are turkey hotdogs, turkey bologna, deli turkey, Braunschweiger sausage, turkey baby food, peanut butter, or EasyCheese Cheddar & Bacon.
Finally, don’t let just anyone draw blood or place catheters. On the human medical side, studies show that the complication rate for catheter placement is 10 times higher for nurses whose competency is rated poor versus those whose catheter placement is rated good to superior. Personally, I’m really good in the exam room, and on the opposite competency scale, my performance in the surgery room is below average. Therefore, I don’t do anything other than routine surgeries, referring all of the complicated stuff to two veterinarians I practice with who can repair a compound, comminuted fracture as easy as tying their shoelaces.
Here’s the bottom line. Use the veterinary nurse who’s the very best at hitting a vein (with the minimum of FAS) to be your phlebotomist. Others can work to increase their proficiency. NOTE: We’ve even had our very best “hitters” take advanced online and practical training and have invested in new equipment that highlights vessels. Everyone benefits, most of all our patients.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.