Butterflies

Recently we have had an influx of transfers -- mostly from small outlying hospitals -- who arrive with a 24ga butterfly that is infusing fluids. We always have to restart them as it is against our policy. Butterflies are not meant to be used as an IV, unless I missed something?

I have also found that the patients complain of pain at the IV site. I also feel I should mention that the IVs are usually wrapped in half a mile of tape with gauze over it. Wondering if this is so I don't notice it is a butterfly??!!

Thoughts, comments?

[Esme12, ASN, BSN, RN]

You mean a real butterfly?

We used to use them all the time.....YEARS AGO....they are cheaper than angiocaths....if they are using them because of price then nursing is in sadder shape than I thought.

[FineAgain]

Yep, Esme, the very ones!

[cayenne06, MSN, CNM]

OMG, yes, we used to use butterflies for GBS prophylaxis when I worked at a birth center years and years ago. Definitely less than ideal. That little needle hurts when it is left in place, and it is way too easy to blow the vein.

Butterflies are much easier to start than angiocaths. But I have never seen them used for IV infusions in a hospital. That is kind of bizarre.

(I will admit though, I use butterflies for blood draws almost exclusively because it is so so much easier for me! Flashback for the win!)

[TU RN]

I'm getting phlebitis just thinking about leaving a steel catheter in somebody's vein and then infusing fluids through it. Red Cross does this all the time with double red donations and I've seen more messed up arms after double reds than not = why I only donate one at a time. Keep the plasma, I'll keep my vasculature.

And I was thinking of starting to donate blood! Yikes!

[TU RN]

Don't let that dissuade you! I'm sure it's not 100% of the time with double red donations, but the process of donating two units at on a is different than donating one. In donating two (ie, "double red"), your blood and plasma are separated and the plasma is reinfused through the same catheter from which it was withdrawn. In my experience, this has led to more complications than your ordinary single unit donations.

[FineAgain]

Yeah we use them for blood draws -- ideal usage. But for infusion? No way. I keep meaning to bring it up at a staff meeting but it is always after a 12 hour night and I forget things.

[iluvivt, BSN, RN]

These an be used for short term infusions and it is often the device of choice for home care patients. Many patients and their caregivers will use a traditional butterfly to gain vascular access to administer various factors,IVIG,Glassia and many other IV drugs that are self administered. As far as the hospital setting goes a much safer choice is a catheter over needle design. I would do exactly what you are doing: resite with a CON device and then taking out the steel butterfly. I also noticed that you mentioned they come wrapped with a Kerlix type roll...it is NOT standard practice to wrap a peripheral IV site with a roller type bandage because it impedes visualization of the site,does not allow for timely assessment and can impede circulation.

[poppycat, ADN, BSN]

When I started practicing in 1978, this was standard for Peds patients. The hospitals I worked at didn't start using angiocaths for Peds IV therapy until about 1980.

They do make butterfly iv start kits, aka scalp vein kits... in 18s, 20s and so on. These are good for people with fragile, superficial or in my experience, difficult veins. The actual needle is pulled, sheath remains. Just like a typical iv

Agree buttterflys should not be used for infusion.

However, what are you gonna do? Of course you need to remove the tape and gauze to view the insertion site...another reason to just restart . Any chance of administration communicating with these facilities... and requesting the correct standard of care?

At one Hospital I worked at, we switched to an IV cath that had wings just like a butterfly. I know they are still in use at facilities. Are you sure that the cath is not that?

[iluvivt, BSN, RN]

I think people are getting confused. There are many IV catheters that are designed with wings that are catheter over needle devices (CON). The wings can serve two functions..they can assist with insertion if they easily fold up and give you something to grip on to. That is why they have pebble like dots on the bottom of the wings. The second purpose is that they can be used to easily stabilize and secure the catheter after insertion. The Intima is a typical example with the needle being pulled after access into the vein of course. What is left in the vein is plastic cannula often made of vialon. The next type of butterfly is the true butterfly, which is just a needle with an extension set attached and often used for blood drawing and one time infusions. I always name the type of device by brand name that I insert inot a vein and only use the term butterfly if I am actually using a non-catheter needle device.

Make sure you know hat you are looking at and there is nothing inherently wrong with a small catheter unless you need a larger one for a specific reason. Use the shortest smallest cannula that will meet your patient's needs. For routine IV therapy a 22 gauge that is working well and is asymptomatic,preferably not at an area of flexion is perfectly acceptable and follows current standards of care for reducing compilations and preserving veins.