Application of attention destruction techniques during factor concentrates infusion to children with Hemophilia

The majority of patients with severe hemophilia A are routinely treated with either on demand or prophylactic replacement therapy.. Modern hemophilia therapy encourages early initiation of  IV factor prophylaxis to children at very young age, aimed at joint preservation. Sometimes treatment of children with Hemophilia may become a traumatic experience for the child, his parent and the caregivers at the hemophilia center.  Fear, cry and aggressive children's behavior are often noted in the burses' treatment room. Due to children's anxiety, coping with the behavioral/ emotional response to the infusions creates a challenge by itself for the patients, parents and caregivers. Notably, as before and during the injection, child's attention is focused on the needle, anxiety during these events may stem from: fear of pain, feeling of control loss and fear of body damage. Currently attempts are being made by Hemophilia center caregivers to reduce children's anxiety using methods like verbal explanations, positive reinforcements following the infusion and gentle or forced hugging, however, this attitude seldom fails. Aim: Our study is aimed at anxiety reduction during IV factor treatment, by using unique attention destruction techniques. Methods: Patients: Study was offered to participation to all parents and children with hemophilia aged 1-12 years, treated at the INH center. Children were assigned first to IV infusion without any attention drawer and then on another infusion their attention was drawn to small objects (eg: toys, TV figures) surprisingly surfing from the ceiling in-front of him, and was operated by the caregivers. Objective parameters of behavior and any emotional responses were recorded using a video camera and later analyzed.  An objective psychological test Yale Preoperative Anxiety Scale (m-YPAS) was applied to quantify children's. situational anxiety and stress. Materials: Yale Preoperative Anxiety Scale (m-YPAS) was used to measure results. The scale is composed of five categories: activity, emotional expressivity, state of arousal, vocalization, use of parents. Attention distraction engines: A special unit of attention destruction was developed, designed and built and have been installed on 4 locations on the infusion room`s ceiling, just above and in front the children's head during the infusion. It is made of 4 separate engines operated by remote controllers, by the nurses. The operation of remote control unit triggered the appearance of toys/ objects approaching the child. Results: The pilot study results show a significant reduction of the Childers fear, anxiety and anger when they were exposed to the attention destruction when compared to the basic infusion.  Conclusion: The pilot study results support the hypothesis that attention destruction can reduce fear, anger and stress in children with Hemophilia during factors infusions.