Drawing blood

klone, MSN, RN · May 28, 2017

I have never done that, the butterfly normally has a grey rubber at the end, how and why are you attaching it to a syringe?

Some of them have leur locks

Julius Seizure · May 28, 2017

I have never done that, the butterfly normally has a grey rubber at the end, how and why are you attaching it to a syringe?

Are you thinking about a vacutainer or a butterfly needle?

emilly.lynn · May 29, 2017

Never heard and saw in my career who uses 60cc syringe to draw blood from a patient.

allnurses Guide · May 29, 2017

I can't picture drawing blood through a butterfly needle attached to a 60cc syringe, or seen anyone else do it. Maybe the OP will come back and fill in the details.

RobbiRN, RN · May 29, 2017

I routinely draw blood with a 12 cc syringe attached to the J-loop when starting IVs or attached to a butterfly when I only need blood and the pt does not have or need an IV. I have to do a redraw about once every three years. It is a myth that the size of the syringe causes hemolysis. You can pull to hard or too fast on any size syringe and ruin the sample. Smaller lumen catheters require more patience and a reduced pulling force on the plunger. Coworkers often say they couldn't get blood from the IV they started. I go draw from their IVs without difficulty about 95% of the time. The two most common problems are that they pull too hard on the plunger, collapsing the vein or sucking a vein wall or valve against the end of the catheter. Mistake number two: pushing or taping the nut where the J-loop screws onto the catheter too tightly, forcing it down into the soft tissue. The nut compresses the vein, restricting or occluding blood flow distal to the site. It seems a 60 cc syringe would make sense if you are miles from civilization and it's the only thing in your bag.

guest2117 · May 29, 2017

I've used a 20 mL syringe attached to a butterfly needle to get blood cultures, never had any issues. I've never attempted to use a syringe larger than that, though.

~Mi Vida Loca~RN, ASN, RN · May 29, 2017

I routinely draw blood with a 12 cc syringe attached to the J-loop when starting IVs or attached to a butterfly when I only need blood and the pt does not have or need an IV. I have to do a redraw about once every three years. It is a myth that the size of the syringe causes hemolysis. You can pull to hard or too fast on any size syringe and ruin the sample. Smaller lumen catheters require more patience and a reduced pulling force on the plunger. Coworkers often say they couldn't get blood from the IV they started. I go draw from their IVs without difficulty about 95% of the time. The two most common problems are that they pull too hard on the plunger, collapsing the vein or sucking a vein wall or valve against the end of the catheter. Mistake number two: pushing or taping the nut where the J-loop screws onto the catheter too tightly, forcing it down into the soft tissue. The nut compresses the vein, restricting or occluding blood flow distal to the site. It seems a 60 cc syringe would make sense if you are miles from civilization and it's the only thing in your bag.

Most butterflys are 25gauge, 23gauge, and 21gauge, while the actual syringe itself may not be what causes the hemolysis (wasn't trying to go that in depth to the simple question, but next time I will) you will have to use more force when pulling back on a 60CC syringe compared to a 20, 10, 5, 3, and 1. Sure you can use to much force on any size, but the chances greatly increase between a 10mL and a 60mL. Add to that the size of the needle itself, you are setting yourself up to have it happen. If you're going to straight stick you would want to have all your ducks in a row to not have to stick the patient again, Now if you're using a regular needle and not a butterfly then great, you can choose a 18 or even a 20 and might not have a problem. (although even with an 18 I still wouldn't opt for a 60. I would rather use 3 20mL syringes if I was needing a large volume of blood via a syringe. (as your best bet would be to just go straight to the vials)

The second possible problem in this scenario is when you're collecting 60mL of blood in the same container through a needle that small it's going to take a while to fill that syringe and your blood can start clotting too. Which again would result in another call from the lab that they need a new sample.

I mean I don't know about other nurses, but I like to be very efficient and utilize my time well. So I prefer to do the most efficient way that will yield the best results and not risk having to re-stick and re-draw the blood. But that's just me.

~Mi Vida Loca~RN, ASN, RN · May 29, 2017

Years ago we would use a 60cc syringe when drawing blood to discard from a sickle cell patient. We drew whatever number of cc's the doctor ordered, then discarded the blood. I don't know if that is still done, as I don't work with that clientele anymore. That said, I wouldn't use a butterfly needle and a 60cc syringe to draw blood for lab studies.

Applewhitern, Do you remember the rationale for this? I'm curious since these patients tend to be pretty anemic already unless it was like some off the record manual dialysis going on. lol But I am guessing there was a legit reason.

So I am wondering what was the theory behind this. I haven't seen it done anymore, but all my sickle cell patients were usually my frequent flyers in the ER. So I don't know if this was more the practice somewhere else.