Angios vs. butterfly intima catheters?

[knurse11]

I recently switched jobs. At my old place of work we used angio caths and I must say wasn't too shabby with them, especially given the average age of the pt on my old floor was 80-85. Now, at this new hospital we use the butterfly/intima catheters and I went from being one of the people you would ask to help you place a line to someone who now dreads when I have to place one/often has to ask for help. I'm dumb founded. The patients I have are actually usually younger, and I've always heard butterfly needles are significantly easier to place. It seems like the whole butterfly needle style needle and me don't get along period because the hospital I'm at now also has me doing blood draws which is new for me and I'm quite crappy with those also.

Does anyone else prefer or feel angios our easier? Does anyone notice any differences in when u insert one or the other? It seems to me that the butterfly/intimas blow easier and that u also have to be a little more patient for the flash. I feel like with butterflys/intimas theres no way to advance the actual catheter also...you have to push plastic and needle in all at once before removing the needle, where as with angios once you hit the vein u could just slide the plastic right in with less of a needle advance...with the intimas theres no way i feel to slide it in because of the way u pull the the needle out. Tips on the best technique for intimas? I think they're a great system really safe, great for blood draws and bloodless system too. I know I must be doing something terribly wrong...

I don't know...I'm so frustrated I wanna be good at both/be prepared to use whatever supplies are at my disposal...argh. Thanks!

[AMR21, BSN, RN]

I worked somewhere that used angios and was fine at placing ivs. (In squirming kiddos!) then switched to somewhere that used the other kind you mentioned. They were so baffling to me. I really think part of it was that I had all this crap to deal with and hold onto while flushing and securing. Never got the hang of those. I now am back to angios and fine. Maybe it is just one of this things that whatever u started w is easiest. I feel your pain, but can't give you Any suggestions other then take some home land practice on your husband like I did. Haha.

[akulahawkRN, ADN, RN, EMT-P]

It's been years since I've used those! I remember placement was relatively easy, but I seemed to prefer to use those for more shallow veins. I recall the insertion technique being fairly similar but because of those "wings" I seem to remember that those allowed for a shallower approach angle that allowed me to get into those shallower veins. Most of the time though, I used the regular angios. The "Protectiv" Catheters are nice in that they safe the needle as you advance the hub. However, the Insyte "Autoguard" devices seemed to be more like the "regular" non-safety angiocaths. They also seemed to be a bit sharper and I recall having a little more difficulty feeling when I'd entered the vein, so I had to get a bit better at the technique so that I wouldn't perf the other wall of the vein.

But yeah, those butterfly-style ones are certainly different and takes a while getting used to them.

[iluvivt, BSN, RN]

Sure I can help with this. There are some differences but I actually love both the intima,nexiva, (catheter over needle butterfly type devices) and the introcan and insyte. You will notice that the intima is a bit shorter than its counterparts. The 22 and 24 gauge is 3/4th inch long and the 20 and 8 are both 1 inch long. So you need to hit that vein soon and cannot really afford to tunnel any of the catheter. I have noticed that the Safe-t-intima is not quite as sharp as the straight type catheter over needle devices. Sometimes depending upon the vein and the patients skin you may have to adjust how you enter the vein. This decision has to be made on a case by case basis. I cannot tell you how many times I think I can use an intima then perform my entry through the skin and I cannot get the intima to puncture into the vein walls outer wall (Tunica Adventitia ). Then I just take it out.....reprep...and go back through the same hole I made with an introcan and then it pops right in. So this may be causing you some problems as well but I can give you some techniques if you only have the option of an intima. I would also start suggesting that you get both types of products. They each have advantages and disadvantages and nurses really need both types in their orificenal IMO.

1. Look at both arms to assess for suitable veins...look for soft full veins. Feel the course of potential veins...take the time needed to look and assess carefully,

2. Take the intima and rotate the safety barrel counterclockwise to unlock the needle. I must admit I skip this step on the 22 and 20 gauge catheters but I do it on the 18 and 16 gauges. You will notice it is much easier to pull the needle back when you do this step

3. I always tighten my flash plug to minimize my risk blood exposure as I found these come loose easily and you look down and there is blood dripping. You can also loosen it a bit or even take it off is you want to get a faster flashback. I will sometimes do this on infant IV starts. You can even pre prime them and attach a needleless connector. I like to do this on patients who have hepatitis or are HIV positive.

4. Perform your venipuncture and enter the skin over the vein or just ever so slightly before you see or feel it is you are using the 24 or 22 gauge. The 20 gauge or larger you do have a bit more length but still need to hit that vein fairly soon so you have enough of the catheter in the vein to prevent an early infiltration because you only have 1/4^th of an inch or so actually in the vein. If you are going for deeper veins or ones you can only feel you need to adjust your angle so it is sharper. Pinch the wings so you are grasping the pebble side. The pebbles help you hold the wings.

5. If the vein is thick walled try to stay on top of it and access it from the top of the vein and not the side otherwise you are just scooting it over with the needle and it makes it very difficult to access it. Soft veins are easy to get into it is the thick walled ones that are tricky. If it is too thick walled loo for another but if you must go for it use a larger gauge not smaller.

6. Once you access the vein drop the angle and advance the catheter slightly more ...do not let go of your traction...do this one handed. If you let go of your traction before you advance the catheter further and it is well enough into the vein that action alone can pop the needle out of the vein.

7. Release wings and stabilize.by putting you thumb on the edge of the wing...DO not put it over the entire wing or you will impede your ability to pull the needle back. This is important... grasp the white needle shield and ONLY PULL the needle back about 1/4^th an inch......you just do not want the needle scraping the vein as you advance it BUT you need the stability of the needle to successfully thread it.

8. Now thread the catheter and you should generally see that the blood is still coming into the tubing unless you are slow and it has filled up already. When that is complete stabilize the edge of the wing with your thumb or if this is the tricky part for you put a tegaderm or TSM dsg over the wings.

9. Grasp white shield and pull back the needle all the way now recess needle..it needs to pulled back all the way so it locks in place.

Try these and see if they help

[casnee]

@ responder thanks for your tips! I have issues with not being able to drop my angle without losing traction. After I get a flash, I drop the angle to advance the needle more but I must move my other hand anchoring the vein out of the way to do so. I've lost potential starts because of veins blowing after doing this. Any tips for hand placement or anything?