A doctor in one of Northern Israel’s community health clinics was at a loss. How was he going to perform an ECG on this energetic and restless four-and-a-half-year-old child who was on the spectrum? After consulting with specialists, the ECG was successfully performed in the Ruth Rappaport Children’s Hospital at Rambam Health Care Campus.
Community doctors often encounter challenges when performing blood tests, transfusions, or ECGs on children – particularly on special needs children. In some cases, the child may cooperate and sit still for several minutes, but for most, this can be a real problem. This was the situation one doctor in Northern Israel recently faced. The child was afraid of medical equipment and could not be persuaded to sit still for even one minute, let alone the several minutes needed to perform an electrocardiogram (ECG).
The community doctor consulted with Yana Levin, the Pediatric Sedation Nurse Coordinator in Rambam’s Ruth Rappaport Children’s Hospital. In order to manage the stress and associated with medical instruments and being cared for by medical staff, the doctor was advised to bring the child to the pediatric hospital’s Outpatient Clinic; the ECG could be performed there while the child was sedated while being held in the arms of a parent.
Sedation is a form of anesthesia that helps the treatment team carry out medical procedures during which the patient – in this case a child – must remain awake. The patient remains awake but the sedation relieves anxiety and minimizes the physical discomfort, avoiding a situation where a procedure must be rescheduled when movement is excessive and the patient does not – or is unable – to cooperate. The sedation procedure requires a skilled team and an environment that meets the safety conditions required by Israel’s Ministry of Health.
In this child’s case, the parents brought their son to Rambam. The staff gave him a face mask for inhaling the sedation. Once the child had visibly calmed down, they were able to perform the ECG. The child was released a few minutes after the procedure, once he had fully recovered from effects of the medication.
Yana Levin explains: “Ruth Rappaport Children’s Hospital aspires to attain a pain-free, trauma-free hospital experience, promoting values that place the patient at the center of medical practice. In general, children, especially those with special needs, may experience anxiety and trauma when meeting with caregivers.” To address this challenge, a Pediatric Sedation Nurse Coordinator talks with children and their families before procedures, explains what will take place, and provides reassuring answers to their questions. The coordinator also works together with the family, and the anesthesiologist and doctor who will perform the procedure to formulate a sedation plan that best suits the child and the procedure itself.
The process clearly works. His mother shares, “When our son sees a doctor, he becomes anxious; so much so, that when he has a cold, I think twice about taking him to the doctor. Since he is so young, he can’t describe his anxiety in words. As soon as I learned that he would undergo an ECG under light sedation, I was relieved. The process was calm and peaceful. Shortly after it was over we left the hospital with a smile.”