[Irishgirl]

I was wondering, there is a debate among nurses in the Hospice I just started working for. Sub Q butterflies are put in bevel up, right? I've only given sub Q injections w/ the needle bevel up. The nurse told me to put it in with the bevel down, (2 nurses, actually) and I did. But then I read the policy (which I should have read first) and it said bevel up. Other than being more uncomfortable, does it even make a difference? Just curious. I spoke to another nurse about this and she said it really doesn't make a different as far as infection, infiltration, discomfort, etc...but I want to be sure. Any insight? I hate being new, I feel dumb. Also, I've never put in a Sub Q butterfly before that day.

[suebird3]

Bevel up is important! If the bevel is down, movement of the needle, however slight, may cause the needle to be occluded; thus, whatever is going in will NOT go in. Example, an IV that is sluggish, etc.

Suebird

[earle58]

depending on who the manufacturer is, i've received kits w/instructions for bevel up and bevel down....

leslie

[Irishgirl]

But...I'm wondering, if it doesn't occlude, b/c it's sub q, so I don't think occlusion would be a problem...it wouldn't affect the absorption of the medication, right? I mean, it's still going into the sub q tissue. My concern is the nurse who I did the butterfly for (it wasn't my pt) won't monitor its effectiveness and the patient may be in pain. I'd hate for a patient to be in pain. Also, a needle can move regardless of bevel up/down, right? Plus, it's kept in place by a dressing.

[Irishgirl]

P.S., what the hell is this icon about ???? Sooo weird.

[suebird3]

I had taken a Phlebotomy course, and the instructor had emphasized the bevel up. His ex is a nurse, and he had stated that there IS a difference. Guess they had some coversations about it.

Oh, the fishy? That is just "for the Halibut".....

Suebird

[earle58]

Originally Posted by Irishgirl

But...I'm wondering, if it doesn't occlude, b/c it's sub q, so I don't think occlusion would be a problem...it wouldn't affect the absorption of the medication, right? I mean, it's still going into the sub q tissue. My concern is the nurse who I did the butterfly for (it wasn't my pt) won't monitor its effectiveness and the patient may be in pain. I'd hate for a patient to be in pain. Also, a needle can move regardless of bevel up/down, right? Plus, it's kept in place by a dressing.

yes, a needle can always migrate, but shouldn't if it's well secured. there's also a little more wiggle room w/the sub q route.
and whether the bevel is up or down, a pt's response to pain should always be carefully followed.

leslie

[doodlemom]

We use sq needles that kind of look like tiny huber needles and they have a sticky pad around it to keep it attached to the pt. These needles go straight in. I like those better beause they don't seem to migrate and they come undone less often.

[silverwillow]

That's the same kind that we use. The direction of the bevel is a non-issue because it points straight down and is just secured with a tegaderm.