Butterfly Vs. 22 gage. What do u use prefer to use?

  1. In my hospital use of butterflies is very much discouraged. My neighbour works in another hospital close by and she says butterflies is what they most commonly use.
    I have no problem using 22 gage, however, most patients on my floor are elderly, bruised and are on blood thinners.
    I am still drawing blood under supervision of the nurse.
    One night, my very expereinced co-worker was drawing a blood on an elderly woman with a butterfly in front of me. The vein collapsed. They had to stick her again.
    2 days later, I was assigned to draw blood on the same patient.
    Explained to the nurse what happened previously, the nurse advised me to go with 22 gage anyway. Of course, I misssed.
    The same tech who worked on this patient 2 days ago came in, had to find another site on the pateint's bruised arm (hands were already out of the question) and stick her again.

    My first question is what do u prefer to use and what is your hospital's policy?

    Second question is should I debate with the nurse who is supervising if i don't feel comfortable using the large needle?

    I usually do what i'm told, but in the case I described, I am looking out for the patient, not for my personal comfort. I felt horrible that night. what would u do?
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    About Anagray

    Joined: May '02; Posts: 338; Likes: 43
    RN; from US
    Specialty: 8 year(s) of experience in ER,med-surg, LTC, psych, dialysis


  3. by   ageless
    For known "bad sticks", I use a 22 jelco with a small (3-5cc) syringe. puts less pressure on the vein and less chance of collapse. I have had many successes with this technique after others have previously failed in their attempts.
  4. by   Nurse Ratched
    I work psych and have three types of patients: addicts (usually with bad veins); mentally unbalanced (uncooperative and/or combative; and confused elderly (generally uncooperative an/or combative with the bonus of bad veins . I know the butterflies are pricier, but when I may only have one shot, I'll go with what will most likely get results which is the butterflies.
  5. by   Nurse Ratched
    Forgot to add that lab does blood draws for the rest of the hospital - our unit is the only one who draws our own labs. If they want something else used, they can send up someone to do it .
  6. by   sunnygirl272
    i do home care, and do the majority of our blood draws...and our wound care ...and our cath changes...lol..just call me scut monkey..anyhooo....i used to only use the straight vacutaineer needles...no only use butterflies...and if you are the one doing the draw..you have the right to choose what needle to use..supervisor can suggest..but i don;t feel they can force you to use soemthing different, unless there is a policy
  7. by   jayna
    Once drawing blood on babies and elderly, I like to use butterfly. But once for IVI I will rather use 22G.
  8. by   SharonH, RN
    I prefer to use the # 21 vacutainer needles. I know they are large but they work faster. I use to swear by the butterflies but they are so slow and I can almost always hit a vein with the #21. Only for the most difficult of patients(and the most anxious) do I use the butterflies.
  9. by   Ted
    I use a 23 guage Vacutainer butterfly (what's supplied on the unit).

  10. by   crispix
    I prefer to use butterflies,they are easier to handle than the 21g vacutainer needles(IMHO)and,if it is a slow draw you can attach a small syringe.
    I have worked on floors where they tell the staff not to use them due to the cost.But,if you are unable to get the blood using a vacutainer,rather than stick the patient several times,why not use a butterfly and do it once?I never could understand their logic,especially since the majority of the patients were ederly with fragile veins.Butterflies just work better,I think.
  11. by   Huganurse
    I use the butterfly/vacutainer system as well most of the time.
    Last edit by Huganurse on Jun 30, '02
  12. by   arbley
    Most nurses have equipment that they prefer, and it varies from one nurse to the next. Personally, I find butterflies a little bit awkward and slow.

    I first learned to draw blood using a vacutainer with a 21g needle. These work ok if you are used to them, but they can collapse some of those puny veins because they can exert too much suction. For cases like that, I prefer a syringe w/22g needle. I shy away from the 23g needles, whether butterfly or not, because the lab folks have drilled into my head that the smalled the needle, the greater the possibilities of hemolysis. If that happens you just have to draw it again anyway. And, think about this. Do you give blood through a small bore IV? Why not? Because small bore IV's can beat up the red blood cells pretty badly sometimes.
  13. by   Christian Nurse
    I was patient care tech in a hospital in Michigan. I did blood draws as well as IV starts. I also worked a predominantly geriatric population and with them I use the "One Stick" rule. If I can't get it on he first try I'll ask someone else to try. So I loved using the butteflies. They seemed easier to use and the "wings" helped guide you. But cost was the main concern on our unit. That's why we had to stop using them so much.
  14. by   ageless

    Just found this article put out by CA pheb. school. (Glad I found it because I couldn't remember the rational exactly right)

    Procedure Using a Butterfly

    The Butterfly or "Winged Infusion Set" is sometimes used on difficult draws such as infants and patients with small veins or veins that may have a tendency to collapse. In recent years, this technique has been improperly used as well as used unnecessarily. Most phlebotomists believe that vacuum tubes can be used on a butterfly. This is incorrect. If the physics of the technique are taken into consideration, as well as to when its necessary to use the butterfly, the industry will see a rapid decline in using this method to draw blood, not to mention a decrease in hemolysis, microclotting and short draws..

    The butterfly would ONLY be used under the following conditions:
    *Neonate / Pediatric draws
    *Small vein draws, such as the back of the hand or foot
    *Uncontrollable patient

    Butterflies should NEVER be used for:
    *Normal draws, using the standard veins in the arm
    *With a vacuum tube

    When suing the butterfly, you should never ever use a evacuated tube. In considering the physics of this devise, the evacuated tube works against you when drawing the blood sample. Also using the wrong size syringe, complicated by pulling too hard on the plunger, will also give basically the same result.

    Consider this:

    The butterfly has a 12" tube. At the other end it has a small bore connector attached to a multi-draw device on which an evacuated tube will be used. A 5 cc evacuated tube must use its vacuum to draw the blood through the tubing from a small vein - thus you have increased pressure on the vein by 40% As the pressure is exerted on the vein, it begins to collapse - perhaps not all the way, allowing some blood to be drawn out. As this pressure is exerting on the vein, it is also "forcing" the blood out, which elongates the cells. This causes microclotting and some hemolysis. Even before the blood enters the tube, this sample is useless. Now, from the point of the needle to the tube, there is a 12" tube that the blood must travel through. As its does, pressure in the tube decreases, drawing the blood slower and slower. By the time the blood reaches the tube, 1/3 of the vacuum has been used to draw the blood. Thus, if there is not enough pressure in the vein, and if the vein is not weak, the additional pressure to fill the tube must come from the patient.

    If the blood sample must be drawn from a small vein, such as the hand, or from a Neonate, the following technique should be used:

    23g needle used with a 5 cc syringe.
    25g needle used with a 3 cc syringe.
    Notice that as the needle reduces in size, so does the syringe. Never ever use a 10 cc syringe. This will double to triple the pressure on the vein as well as cause microclotting and hemolysis. Always match the syringe with the needle used. If your using a 22g needle, a 3 cc to 5 cc syringe can be used. Never pull faster than the blood will allow. When using a butterfly, you have chosen to draw only the amount of blood needed for the tests, and the size of the syringe your using will accommodate all the tubes, using microtainer if necessary. As you pull back on the plunger, so not pull faster than the blood will allow.
    Do not pull on the syringe plunger faster then the blood will allow.
    You are in complete control of the pressure on the vein and on the cells. Thus increasing your chance of a good sample

    Following these major decision factors in determining when and how to use the butterfly, the usage's of this devise will decline. Its unknown why phlebotomists feel that the butterfly should be used for normal draws. Many say that its because they are drawing from a small vein that could collapse. This makes no sense because using the butterfly on a vein that may collapse using a vacuum tube, does not prevent this because the phlebotomist is not in total control of how much pressure is exerted on the vein.

    Syringe Draws

    Although the preferred method of obtaining a venipuncture specimen is using the evacuated multi-draw, the use of a syringe may become necessary in patients where your unsure of getting a vein, or veins that may collapse. When using an evacuated tube, you only know if your in the vein by site and sound. The site of seeing the needle go into the vein and the blood being drawn into the tube, and hearing the pop sound as the needle enters the vein. Therefore, if you can't hear the pop sound and if no blood enters the tube, then you have to dig around for it, or draw again.

    The syringe can be used as a safety margin for those unsure of draws. Using the syringe, a blood spot will appear in the hub of the syringe when the needle has entered the vein. By pulling slowly at first and then increasing the tension to the median limit of the vein, a complete successful draw can be made. Using the same puncture site with an evacuated tube could have not been successful because the vein was too weak to accommodate the pressure of the tube. Again, as we stated describing the butterfly, you are in complete control when using the syringe.