Taking the Work Out of Blood Work: A Provider's Guide

Tips to Help Your Patients with ASD Have a Successful Blood Draw

Before The Visit

• Educate yourself about the patient's disability in order to understand why some reactions may occur and what adaptations might be needed (e.g., environmental sensitivities, receptive communication level).
• Plan ahead of time for the visit.
• Schedule patients with ASD for the first or last appointment (when the office is less busy).
• If the patient will have to undergo multiple blood draws for different reasons, consider coordinating them to be completed with 1 stick rather than multiple sticks.
• If the patient will be sedated for a different procedure, considering scheduling the blood draw while the patient is under sedation.
• A brief written protocol may help staff and practitioners become more coordinated in their approach to patients with ASD.
• Since many children with ASD have restricted or preferred interests, find out ahead of time what these might be. Ask the parent to bring an activity or toy that relates to this interest, which may help make the appointment run more smoothly.
• Have a backup plan determined before the procedure begins (e.g., when to stop the procedure, move more quickly, call for more assistance).
• Set up equipment and all necessary materials prior to the patient entering the room.
• Consider using child-friendly equipment, such winged infusion sets that allow more movement.
• Discuss plans with your patient's parent.

During the Visit

• Remain calm and flexible. Avoid appearing emotionally reactive or "frazzled" by the patient's behavior. Do not take the behavior personally.
• Allow the child to feel they have some control by allowing choice whenever possible (e.g., pick the color of a bandage or wrap).
• Prioritize what is most important to accomplish in this visit and avoid power struggles.
• Expose the child to certain items that he or she may have a strong reaction to before it has to be used (e.g., allow them to see what the alcohol smells like, what the texture of the tourniquet feels like, etc.) based on parent's input of their child's sensory vulnerabilities.
• Consider changing any aspects of the appointment that will get the patient to the next step successfully.
• Explain what you are doing before you do it. Check for understanding. Be direct about what you are doing and whether it will hurt, if the child asks.
• Use simple, concrete language in short sentences without idioms, irony, or metaphors.
• Give direct requests (e.g., "Please sit here" vs. "Why don't you come over here and sit?")
• Refer to parent for behavior management, communication, and patient preferences.

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These materials are the product of on-going activities of the Autism Speaks Autism Treatment Network, a funded program of Autism Speaks. It is supported by cooperative agreement UA3 MC 11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. Website hosting, design, and maintenance provided by the Vanderbilt Kennedy Center.