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Time to change phlebotomy? A short story
  1. Claire Connellan,
  2. Lisa Dann,
  3. Orla Flanagan
  1. Department of Paediatrics, Galway University Hospital, Galway, Ireland
  1. Correspondence to Dr Claire Connellan, Department of Paediatrics, Galway University Hospital, Galway H91 YR71, Ireland; claire3connellan{at}

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Children can find hospitals and procedures stressful. This is particularly true for children with intellectual disabilities or autism spectrum disorder (ASD). These children can find phlebotomy distressing and often need repeated testing due to medications and screening tests for associated diseases.1 2 Social stories are simple, picture stories that are used by children with ASD and intellectual disabilities to prepare them for everyday activities, for example, bed-time or school. With the success of visual cues and social stories in other areas of management, we elected to introduce this for phlebotomy. At the time of writing, we were unable to find published literature on their use in phlebotomy.


A social story was constructed. This was a brief five-page, picture document that demonstrates to the child what occurs during the hospital visit. This was paired with a ‘phlebotomy pack’ containing items required for phlebotomy with the needle removed from the bloodletting device (see online supplementary figure). Patients and parents practised with the story and kit and returned 1–2 weeks later.

Children were selected on a case-by-case basis. Those who had previously required oral sedation or had distressing experiences were selected. Success was determined by successful phlebotomy, reduced reported anxiety levels (parental survey) and avoidance of oral sedation. Ten children received the pack and all were included in the study.


The pack was given to 10 patients. Nine out of 10 patients had successful phlebotomy without sedation. One child required oral sedation for phlebotomy. However, he managed the entire process until the needle was present with improved tolerability and less distress for both him and his mother.

Parental surveys were distributed after the clinic visit. Parents were asked to rate the stress of the phlebotomy experience from 1 to 10, with 1 being the most stressful and 10 the most positive. Parental surveys demonstrated significant reduction in their anxiety. Given that this is a subjective measure, we asked them to compare and rate a previous phlebotomy attempt also (figure 1). We have included quotes from parents in box 1. All parents unanimously reported that they believed their child’s anxiety was reduced and that they would use it again in the future.

Figure 1

Parental rating of experience with phlebotomy.

Box 1

Parental quotes

  • A fantastic improvement.

  • I knew I had done something constructive to help him.

  • A complete transformation.

  • Without a doubt we would use it again.


While this has only been used on a select number of patients, we have seen remarkable results. The use of both the social story and sensory pack helped alleviate anxiety and 90% of children had successful phlebotomy without requiring sedation.

A social story is a non-intrusive, easily implemented intervention that appears to be effective for providing social information for children with ASD.3 There is a paucity of evidence behind their use, with no published reports on their use in phlebotomy. We have used it on a limited number of patients but with remarkable success.


The use of social stories with sensory packs have helped alleviate anxiety and resulted in more successful clinic appointments and phlebotomy. We plan to continue distributing the story to our population and will publish future data surrounding this.



  • CC and LD contributed equally.

  • Contributors CC and LD contributed equally to this paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. A supplementary figure has been added.

  • Patient consent for publication Not required.