blood sample with a butterfly needle

Nurses General Nursing

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:nurse: hello!

well, so now i have a job as a nurse and i am very happy about it, no more retail!!! yeah! anyways, i start this job about 3 weeks ago and i like it, so far the nurses and ma's are very nice and really helpful, especially for a new nurse like me. during this time, in between all the different duties that i have, one is drawing blood and let me tell you i am getting better everyday, but everything is ok until the pt asks me to use a butterfly needle, either because the veins are looking so tinny or because they believe a little needle is less painful. well i do everything as i was taught, i see the flow of blood that let you now you found the vein and everything, but when i push the tube to get the blood, the blood does not run as fast as it suppose to and some times does not run at all...and i can not have my pt waiting for hours for the blood fill the 3 tubes that a need to fill for obvious reasons...so i end taking out the needle and asking some body else to please get the sample for me. what am i doing wrong? i saw my co-workers do it and they do not have any problem. please help.:(

Specializes in Psych, ER, Resp/Med, LTC, Education.

Not sure what size butterflies you have --you mention having larger bore ones and well, what's the point then!? lol

I have had both stuck in me and the butterfly does hurt less........though this was a 22G or 23G, the regular one like a 20. The problem is that if you are in the AC and have a really large vein and a tiny 22 or 23G that is a lot of pressure and sometimes they will blow, same thing trying to put a 22G IV into a huge vein....as far as blood flow there is a big difference, especially if you are used to looking at the rate coming from a 20. The butterflies are usually smaller so the blood has to get through that. And keep in mind having the blood coming out too fast can break the blood cells and you do end up with a hemolyzed tube. Also I find that other then readjusting the needle itself i sometimes will take my other hand and make a V with my fingers, straddle the vein just above the needle, like 1/4 of an inch and lightly pull the skin away from the needle to straighten the vein more. You can also try this by pulling the skin on the other side of the needle and pulling away from the needle towards yourself. This too will pull the vein more taught. You can also ever so lightly milk the vein, rubbing the actual vein down towards the needle--very lightly, being careful not to touch the needle. I have gotten blood from a rock --so to say! lol You sometimes just have to be patient. If the floow stops you may be up against a valve in the

vessel and puttling back just a hair might help.

Good luck!

Specializes in CT ICU, OR, Orthopedic.
I still don't understand why people always ask for a butterfly. The needle is shorter, but still a 23g just like the reg needles! Some of our butterflies are even 20g, which is larger in diameter than the reg phlebotomy supplies. I guess they see the shorter needle and in their mind it is "smaller". I don't mind using a butterfly if it's a nice surface vein, like in the hand or forearm, or in an infant, but it is easier for me to use the reg needle that I'm used to handling a thousand times a day.

In our area hospitals, butterflies are the only thing stocked...I still have a hard time cuz I was trained with a regular one....I think the hospitals feel it reduces needle sticks for staff?

Specializes in ICU, Home Health Care, End of Life, LTC.

I am doing my community health clinical rotation in a free clinic and I do lots of blood draws. I used to be terrible. The angle they teach you in books is all wrong. My text had shown penetrating at a 45 degree angle. I now use 15-15 degrees.

I hate the butterflys too. I think the previous posters had some good ideas. For my two :twocents: my coworker (the inhouse vein whisperer) taught me not to be "wimpy" or afraid when inserting the needle. Make a good solid drive right into the vein. Always palpate the vein and do so for a little distance above and below your target area. Choose your vein based on feel never sighty. Hold the needle paralell with the vein. If you go in good and solid the pull back a little is OK but watch for pulling back too far.

My latest problem is I put the tournequet on too tight. I want those veins to stand up so I can pop into them. Unfortunately that means sometimes I pop them or I cut off the supply and it slows after the first tube. Try not to have the tournequet on too long also. If I have a hard time finding a vein once I have found it. I will take the tournequet off for a moment while I place supplies, glove up etc. I also tell the patients who are nervous not to watch with a little humor. "You don't have to watch, thats my job." I also lighten things up by saying I have done this many times "and it's never hurt me once." Unfortunately not true, be careful disposing of the butterfly/needle.

My remaining problem is that the needle or butterfly often shifts/moves while I am reaching for or changing tubes. Any suggestions?

Sometimes i had to pull out a little with the needle or move it around GENTLY to find the vein ..and the blood usually comes flowing through

Kind of unrelated, but I had an experience as a patient with both ways of drawing blood. The first time I got really dizzy and didn't feel well, so the nurse suggested for me to request a butterfly needle the next time I get blood drawn. So next time comes around and I asked for it, and was obliged. I didn't feel dizzy or sick that time.

From what I understand in this thread, blood does not flow as quickly out of a butterfly. Is that why I didn't feel dizzy, or was it just a coincidence? (I don't always feel yucky after blood draws.)

Specializes in Public Health, TB.

"My remaining problem is that the needle or butterfly often shifts/moves while I am reaching for or changing tubes. Any suggestions?"

When I need to draw multiple tubes, such as needing a rainbow plus blood cultures, I tape the butterfly wings to the arm to stabilize, then I can use both hands to switch the tubes and culture bottles on and off the end. Obviously this requires a low angle of insertion into an arm vein, and the cooperation of the patient. I learned this when I worked on a renal floor and occasionally would need to access a dialysis fistula.

I just hold the butterfly needle with one hand and have tubes in my lap and use other hand to single handedly (is that a word) pull tubes out, p/u other tube and insert with free hand. Takes some practice, but sometimes the vein is to deep to tape butterfly down. I am partial to using regular needles to draw blood, can't stand the butterflys unless it is a hand draw or a very small vein. I like the deep vein, the deeper the better for me.

Specializes in OR.

you just have to become a little bit ambidexterous :p

i set everything up when i do my blood draws. ill hold the needle with my right hand once its in the vein and be very careful to NOT move it at ALL once i see the flash... then i reach with the tubes in my left and plug them in the vacuum seal being careful not to move my right hand.

just takes practice. i got used to doing this at 0300 and tired, so it was good practice :p

Just love butterflies, I use them with a syringe or with the holders, most of my colleques hate them, easy to use, especially with mulitple tubes, have taken 25 tubes using them, fantastic for a hand or foot bleed also.

I use them always when doing children their viens are so much smaller and the chance of them moving also they love to watch the blood go through the tubes.

We get many patients with parkinsons too, with the shakes the tube is great they dont feel as anxious or worried about their movements, really good.

Rosemary, Australia

Specializes in Step-down, cardiac.
Penetration is easier when the "bevel" of the needle-point is facing away from the surface being penetrated (lower surface area in contact = higher pressure at point of contact = lesser force required to achieve penetration).

Thank you so much for sharing that! I always put the bevel up, like you're supposed to, but I never knew why!

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
I still don't understand why people always ask for a butterfly. The needle is shorter, but still a 23g just like the reg needles! Some of our butterflies are even 20g, which is larger in diameter than the reg phlebotomy supplies. I guess they see the shorter needle and in their mind it is "smaller". I don't mind using a butterfly if it's a nice surface vein, like in the hand or forearm, or in an infant, but it is easier for me to use the reg needle that I'm used to handling a thousand times a day.

It's not the size of the needle that matters. It's the changing of the tubes when you are using a straight needle/vacutainer combo. When you change the tubes you inevitably move the needle somewhat (some more than others) that's what hurts. With the butterfly you have the advantage of the extra tubing which lets you change the tubes without disturbing the needle...unless you are like me and catch your finger in the tubing while reaching for a tube thereby ripping out the needle and having to start all over. :eek:

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