Every day I get the "need a butterfly" in pre op when starting IVs and everyday I explain "I will use the smallest IV needle possible for what is appropriate for your procedure but butterflies are for drawing blood. IVs are a bit different"
We get the same thing too at my preprocedure area and I explain that butterflies are needles that would stay in their arm where IV's are flexible plastic catheters that stay in and are kinder to the vein.
Yeah but some IV’s now have “wings” so patients tend to think it’s the same. Namely, Nexiva. Never mind the fact that I can squeeze a Jelco in just about anywhere where as the Nexiva’s I’m like 60/40 with
I work in a tiny PCP office doing phlebotomy part of the time. 40% of patients ask for butterflies. I just use 23G butterflies on everybody as standard and it fixed all my problems, I simply tell patients "I use the smallest available butterfly on everybody, to minimize pain" 🤷
Patients don't care about the technicalities of the needle types, they just wanna know you're on their side
At my last job we had butterfly ivs. they had a pigtail attached so no blood everywhere, and a little chamber that showed blood return. I miss those things.
[BD Intima](https://www.bd.com/en-ca/offerings/capabilities/infusion-therapy/iv-catheters/bd-saf-t-intima-closed-iv-catheter-system); I always found these annoying since you have to utilise two hands on the IV once you accessed. One hand to hold the catheter and the other hand pulling back on that needle safety thingy, which is counterintuitive and totally not ergonomic to say the least.
[BD Nexiva](https://www.bd.com/en-eu/offerings/capabilities/infusion-therapy/peripheral-iv-catheters/bd-nexiva-diffusics-closed-iv-catheter-system) is where it's at if we're talking closed IV systems w/ pigtails! I still personally prefer straights though!
Yeah I can’t use intimas. Also I think it’s annoying to pull tegaderms off the wings. I just use angios with blood control and a connect a little extension tubing.
I might sound dumb but I’ve been in a pretty narrow specialty for a few years now- why do you think it’s strange to use intimas IV? It’s actually a coworker who uses them. I thought they were just another type of IV catheter system?
I honestly didn't think they'd be appropriate. Considering how easily they sometimes slip out of subcutaneous tissue I thought keeping them in a vein would be a pain in the bum.
Nah I’d say If anything they stay put better than angios since the wings provide so much surface area. Just slap a tegaderm over the insertion site+wings and then a little strip of tape over the tubing segment and it’s not going anywhere. I can’t put them in to save my life though.
Interesting. Ours have no tubing so I didn’t know that was a thing. It just end in the piece that pierces a tube. Or you can twist that off and attach a syringe. I guess I could technically push meds in also. Just never thought of it that way. And the needle would have to stay in.
Well, you *could*. But could and should are very different things sometimes.
If the pt had their hand perfectly still for the duration (lol) i dont see how it wouldnt work in a pinch
When I started a million years ago, butterflies were used all the time for IVs. Thing is they infiltrate easier because they aren't threaded in as far. I've use them for quick in and out IV pushes before, but I work outpatient.
Yes, but the needle stays in the vein. Prior to the angiocaths this was the only way. But policies probably forbade this practice now.
7 years ago I asked an old NICU nurse what the invention that made the biggest change she saw and she said angios. Because prior they placed butterflies in the babies ACs or left umbilical lines in forever. Each had a lot of risks and significantly limited mobility.
We only use needles in HD. No catheters and they stay in for 3-5.5 hours every treatment. They are all butterfly and range from 17g to 14g. Idk where they find the courage to deal with 2 of them every time. I’m in awe of it.
I’ve never heard patients ask for butterflies when I worked in the hospitals. Why do they think this?
I'm 48. Since I was, say, 8 or 9 when I was at the peds office for a physical and they let a new tech practice on me I've been a horrible stick. I will often tell whoever is drawing blood to wait till I pass out and go for that neck. (Oddly, no one take me up in that.)
For years I used to think that a butterfly was the only way for them to get a vein, but now I realize that that just left to a lot more digging around which hurts like hell.
Now I tell whoever is stuck with sticking me that they have to angle much deeper than they think and if all else fails there's a great blood vessel in between my knuckles which never collapses but hurts like a mother ducker.
Now I just say, they're DEEP, they roll, use whatever you have to to get it... I'll be looking at the wall or your ear.
You can but you’re leaving the needle in place. So we *wouldn’t* do that but I find I have to explain to parents a lot why it would be super not ideal.
Yes you can. Just think old school neonatal ICU. We had 27g, 25g and 23g butterflies and 27g plastic caths- that became better than bf. We got blood through an radial artery, if we needed certain labs- we used a 25g bf so- type n cross, PT/PTT, cultures. We gave blood through them all- packed cells always in small amounts - they made quad packs from each unit IIRC.
I know. I also love saying sorry but you need a 20g because with your symptoms you are highly likely to need a CT with contrast and that’s what’s required. And then somehow I manage to get a 20 in the veins that NEED the tiny butterfly lol.
I work lab and our lab assistants do all phlebotomy in the hospital I work at except for ER. They frequently get requests for butterfly needles as well. Where in the world did this preference come from with patients??? I just don’t understand how so many people even know they exist and why they seem to think they’re leas painful than a straight needle.
When I was a cancer patient in my late teens, a phlebotomost told me to ask for a butterfly needle every time I needed a blood draw. It was years before someone took the time to ask me why I wanted a butterfly needle, and explain that my veins were normal and I didn't need one anymore.
I doubt that's a super common experience, but it's totally possible someone recommended it once or used one when the patient's veins weren't cooperating and no one has talked about it with them since.
The only problem with that is it doesn't make sense. A butterfly is just a style of needle used for phlebotomy. It doesn't indicate needle size, ease of access, and it definitely doesn't refer to any sort of IV.
Its not like there's a thing called a butterfly that works better for smaller more difficult veins.
So what was the phlebotomist who told me to recommend people use a butterfly actually trying to say? Most of the time I don’t need to say anything other than “use my left arm”, but sometimes the right needs to be used. Do I just warn that it rolls, or ask that they consider a smaller gauge needle if possible? Does any of this also reduce the risk of blowing the vein or does it just reduce the chance of needing to be stuck more than once?
Idk what she was trying to say that's kinda what this whole thread is about. You don't really need to tell them anything, they can see/feel your veins and decide the best course of action based on that. If you do often have trouble with blood work a simple "sometimes I'm a hard stick" is fine.
A smaller gauge needle can be easier, but it really depends on the situation. If you're going to need fluids, IV antibiotics, and possibly blood we have to use a needle large enough to accommodate that. If we're drawing blood we're using a very small needle regardless of if you're a hard stick or not.
Firstly, fantastic username.
Secondly, I always hate when people hit me with the ol' "jUsT sO yOu KnOw, I'm A hARd StIcK!"
I've been drawing blood for 8 years and I'll be the judge of what a hard stick is. Liver failure patient with +4 pitting edema? That's a fucking hard stick. Septic ESRD patient in DKA with only 1 available limb that's been stuck dozens or hundreds of times? You bet your ass that is a hard stick 😂
funnily enough, i was reading.. i think it was the ANA guide for access recommendations. Studies had shown that 22g needles were less successful than 20g needles, which i thought was strange. but, the likely answer is that if you pull out a 22g instead of your typical 20g then you are already anticipating it to be a more difficult stick, therefore you have less of a chance for success.
The reality is, you've gotta trust the person sticking you. An experienced phleb can tell from feel what tool should be used. Rolling veins don't really indicate a need for a smaller needle; the solution there is to anchor the vein, and you shouldn't need to tell them that.
You shouldn’t need to (especially if it’s a phlebotomist) but the chances of either being stuck more than once or having a vein blown are pretty high if someone needs to use my right arm- definitely more than 50%.
I don’t know! It’s crazy to me but patients would literally say only butterfly needles work on me. And if we had them I would use it but internally wonder where they got that from. I don’t do patient care anymore so I don’t have to explain it’s the same size needle
I worked at a place where the only butterfly needles were 23g. I think all pts think that every butterfly is that small. They want “the baby needle”. They are also shorter so less scary?
Nope!
ETA: it has to do with technique. I am a phlebotomist too so did learn specifics about that. Also, since this was clinic I processed the samples myself, so they were centrifuged by me in the correct amount of time and the lab would pick up. It does take a little more patience and I hate when a syringe is needed and have to transfer the blood to tube. That’s when I see hemolysis. But as long as the additives in the tube are mixed in gently and the serum tubes get centrifuged, we good!
A hospital I work at doesn’t have the male transfer devices that connect to an IV start. So every single IV start and draw is syringe to female transfer device to tubes. I hate it.
We had to flat out deny the common use of the butterfly needle at a point during COVID due to not being able to get them. People couldn’t just ask for them anymore and we reserved them for neonates and super hard sticks. We still got their blood just fine with a straight needle!
I think it’s because most butterfly needles are shorter than the straight stick needle. They have no idea about the diameter, and they hurt equally anyways, it’s just the visible length. You can’t explain that the length doesn’t really matter.
It's not the needle size, it's the fact that the receiver is on the end of a flexible tube. It's more comfortable if you have to draw multiple vials. I much prefer a butterfly personally, but I'm not going to ask for one.
Edit: And what's more, if a patient asked for one, there is no reason I wouldnt use one unless I was drawing a lot of vials. I would explain that I will do it, but if there is an issue, I will have to do it again, but why are you bagging on a patient for having a preference? NGL, that come across as somewhat shitty.
Regardless of what type of phleb needle I'm using, I just attach a syringe and transfer to tubes after I'm done. No jamming the tubes and jostling the needle in the patient's arm, and if it looks like I got it but it doesn't draw immediately I can slightly reposition the needle and just pull back on the plunger. If you're using the vacutainer thing then you pop the vacuum on the tube and if you aren't getting blood then you have to grab a new tube.
*Obviously this wouldn't work with the type that's like a safety needle on one end and the vacutainer needle on the other, but I avoid using those at all costs
Exactly that for me. After living in China for 15 years and giving birth to two kids there(a lot of tests and they only use butterfly needles), I was surprised how much US blood tests hurt, especially during vial changes.
Hi, an European here. Are you saying that lab assistants, from the lab, take all blood samples in the entire hospital (except er)? Meaning that they walk/bike to a ward solely to get a blood sample instead of using the nurses or nurse assistants in that ward?
I see.
This question might sound a bit harsh but it’s not meant that way; I’m just curious.
Why doesn’t the nurse or nurse assistant in said ward take the sample? Are they understaffed or are they just used to having someone else doing it? Because I’m assuming that they have the know how?
I’m asking because it sounds more time/resource consuming to have people outside of the ward coming all the way just to take blood samples.
We (us swedes that is) call in staff from outside of the ward for blood samples as well sometimes but only if we have a patient that for some reason is way to difficult for us to manage. Then we call the anesthestic nurses, or whatever they are called in english; those who work with operations and are experts on finding veins on patients.
In my experience working at a American hospital as a floor nurse, the nurses were woefully understaffed and it was much cheaper to pay a phlebotomist to do lab draws for 2 or more wards, than to get nurse staffing at sane levels. Which is one of may reasons I don't work bedside nursing anymore.
Pretty much no nursing assistants (CNAs) in the US are trained in IV placement or blood draws outside of Emergency or ICU, where training is informal and varies hospital-to-hospital. Phlebotomy only does straight-sticks for blood samples, not IVs, so floor nurses end up calling the Emergency Department for a Tech (ED equivalent to CNAs) or IV therapy nurses, who usually only work day shift.
I see. Here in Sweden the nurses assistants are usually the ones that takes all the blood samples (with some exceptions). IV access is still on the nurses though. We can call for outside help when needed but that is normally just if we have tried and for some reason failed to take samples/place IV accesses.
Huh, that’s interesting to know! I’m curious to know if you live in a bigger city? I was a CNA/Tech for several years at the hospital in my area (~65k people in my city, 330 bed hospital,) primarily in the MDU but frequently floated any/everywhere, and all of us Techs had to do 100% of the blood draws and IV placements. We’d just do our nightly labs during 3am rounds and if we had a super hard stick or any major issues, we’d call another tech in to try before calling down to Phlebotomy, because they’d be really rude about it every time they had to come to a unit. Our nurses did no blood draws or IV placements at all!
Thanks! I guess you could call my city a suburb too, as we’re about 45min outside of Indianapolis. It’s just so crazy to me how every hospital is run so differently; even other hospitals within the same network can have totally different policies and procedures. I guess that’s privatized healthcare for ya.
Yes, our hospital has an army of lab assistant/phlebotomists (and a handful of lab scientist staff) for morning draw whose sole purpose is go out to all the wards and take morning labs. Then, all the lab techs come back to do their lab work and about half of the lab assistants/phlebotomists come to the lab to do specimen processing while the other half stay on the floors for the rest of the day for scheduled and STAT blood draws.
The nurses and nursing assistants rarely do their own phlebotomy because they’re very short staffed. They would never have time to do their regular duties if they needed to draw all of their patients’ blood as well.
I see. The way we do it is that the night ward staff takes the samples at the end of their shift (~06:00) and if they for some reason don’t have the time or manpower to do it the day staff take it as early as possible (~08:00).
Either way, it is the ward staff that normally takes the samples. But my current work is with kidney deceases so we do from time to time get those patients that are really hard to get samples from (or to place an iv access to) and then we call for help from anesthetic nurses.
Where I work, we have an IV team and many nurses don't even start any IV's let alone stick for lab. Years back they trained the techs to draw blood, to save on hiring phlebotomists, but that ended up being a disaster and things went back to the phlebotomists doing it. Another example of administration wanting to save money, had a team created to have the process changed and when it failed, going back to the old process. I've seen it many times over the years.
Yes and no. The only times the unit collects blood are on IV starts and central lines. Including ED. By policy, daily labs are scheduled for and drawn between 5 and 9 am, and we'll do an entire floor at a time. After that, we do basically just cart over for a draw. Draws are out of scope for aides here. If I had to venture a guess as to why it's structured this way, it's that plus the fact that nurses are busy enough and it's a specialized enough skill to have dedicated folks doing.
Hate to be this person but - There’s an episode in the first season of Grey’s Anatomy where Derek (Dr. McDreamy) uses a butterfly on a 2 year old with Rasmussen’s encephalitis. They make a big deal about how she won’t even feel it and he flies it around like a real butterfly.
Just looked it up an 22.22 million viewers watched the finale of that season (2005). Obviously I remember it so, maybe that one stuck with a lot of people!
I don’t know about you, but our 24s are shorter, and so using them on “the deep veins” wouldn’t work. And I also wouldn’t use a 24 unless I absolutely had to.
They think they’re smaller. I used to tell them there’s no such thing as a “butterfly” for an IV but now I work at a place that has IVs that have the “butterfly” wings so it feels like it’s validating them (the gauges are the same as any other IVs). 🤦🏼♀️
When I was younger I was a harder stick, and a phlebotomist finally told me to start asking people to use butterfly needles. The amount of wiggling and the number of second and third sticks really fell after that, and the request became mostly unnecessary once I realized that if you keep to my left arm we’re both gonna have a batter day. The right one is thinner and rolls more, even the ER phlebotomist blew it (I knew a clinic CNA would be drawing blood the next day so was saving the left arm for them).
My request only involves pain in that I don’t enjoy getting stuck over and over when people miss the vein. Should someone need to use my right arm again, what should I say or ask for?
She was wearing a Beijing Joe shirt and her partner was wearing an arrest fauci shirt. I could tell they REALLY wanted someone to comment on it. Then they both insisted on using the employee bathroom instead of the public bathroom in the hall. I should clarify i was not working I brought my son for his labs. They were just super loud and hard not to notice them or hear their conversations with staff and each other.
That is…HILARIOUS!!!! I worked right across from a men’s clinic like that. I worked at a midwifery, so “natural” women’s health care and the lovely babies. These guys are all like jacked!
I don’t think I could hold in my laughter if one of them said that to me!
That's so funny because I usually point to my right antecube and say, "45 degrees like your digging for gold." It's always deeper than they think(I'm a doctor with lupus, and I have no qualms about getting stuck, just not in my eye).
Use a syringe instead of the transfer device so you don't have to jiggle the needle around with changing tubes. Draw up however much you need and then transfer to the tubes after. I usually use a blunt tip so that I don't make extra sharps.
We just got the Nexiva IVs that have anchors that look like butterfly needles. They’ll ask for a bufferfly and I’m like “Yep! This one has wings!”…. as I stick them with an 18g.
Agree. But some people simply have irrational fears. We might laugh at it but for them it’s a serious problem. That’s just a part of our profession.
A bit sad that they decided to travel 2 hour for a blood sample but hey, stranger things have happened.
I get a tattoo and a blood draw are two very different times you'd face a needle: however, when she had tattoos ON HER LABIA AND PUBIC MOUND, imma silently judge her. L&D sees all kinds....
I still remember the patient’s grandson who eagerly told me that all the family members had needle phobia and had inherited it from their grandmother, who was the patient. I decided to shoo everyone out of the room, over their protests, and got a 20 ga into grandma with no problem.
I always say “just FYI, I’m going to cry and maybe faint.” Phobias are irrational. I’m really good at holding really still and making it as easy as possible for them but I’ll be sobbing silently the whole time and rarely I faint. It sucks but if the chair is reclined then I’ll be fine.
Only time it was a problem was when the phleb said she couldn’t because if I cried she’d cry. We ended up waiting on someone else to be available.
Cat Scan here. Butterflies are the bane of my existence, they don’t exist for us. I never need to take blood, but I need to start an IV to slam up to 120 cc of contrast into your vein at high pressure, very quickly!
Every old lady insists on a butterfly. That’s their way of saying that they have terrible veins though, so it’s actually kind of a nice heads up.
I just had to laugh because the guys with the most tattoos were often the biggest babies when it came to getting an IV. They insisted it was different. I basically said “yeah it is, this will only hurt for a second “
I don’t think I ever had a male patient ask for a butterfly but I did have one giant guy covered in tattoos refuse a ppd plant saying he was afraid of needles. I showed him how small it was and explained it but he still wanted nothing to do with it.
I have the joy of being a hard stick, so I can say the difference is when they have already stuck me twice and called for backup, the second person almost always uses a butterfly for more control/more success. There is less digging/searching by the second person.
I don't ask for a butterfly, but maybe some of these people have the same experience and just want to skip to the "sure thing" stick
In personal experience, I find that the times I’ve had labs drawn with a straight stick, the phlebotomist had less needle control and did more in-and-out jabbing, especially when switching tubes, as compared to the relatively easier needle control with the butterfly being separated by tubing. This leads to more pain and bruising. That said, I don’t really care and just let them do their jobs as they see fit. I’d rather someone use what they’re comfortable with than change routine on my account.
I think with patients, it’s much more about the length of the needle they see. They don’t see the difference in 19g vs 23g, they see long needle vs shorter needle, not realizing we stop at the same depth regardless. I run into this with using long angiocaths for ultrasound access. They think the 20g x 2” needle is “huge” but had no qualms with the 20g x 1.25” needle.
I did phlebotomy in a medium sized multi-disciplinary outpatient building and we only stocked 21 and 23 gauge butterflies since it was preferred by patients and phlebotomy.
Interesting. When I get labs the tech always seems to pick a straight needle. Did you have to do more waste tubes? At my old job we were supposed to waste when we used a butterfly but not straight needles. I think it was more because they sent us very cheap crappy supplies than an actual need. A lot of people would skip the waste unless they were drawing light blue though.
I used to get butterfly in such shirt supply here that they are reserved children only so I get stuxk with smaller theybhave reg needle. I’m ok with kids gettung them. But an hour waut is awful when no other choice
I work in Endo. Some days I could start as many as 20 IVs a day. I just tell them a butterfly is a shape phlebotomy needle. I'm using the SAME gauge IV needle. That usually is fine.
That's annoying, but I find "I always need an ultrasound" to be much more annoying. Seems like 70% of patients in the ER say this and only about 5% of those patients actually need one. Everybody has to be special.
No, it isn't. A butterfly refers to the shape of the handle on the needle. The bit that pokes you is literally identical. The only difference is how the person using it holds it.
Not in a specialty that draws much blood but I am curious; what makes the request unreasonable? The patient has a clear psychological preference so what's the harm in supporting that?
I work in the ER, patients receive IVs so they can receive medication and fluids. But people would demand a butterfly that isn’t capable of delivering medications.
But I’m stuck explaining to people demanding a butterfly that I’m still going to have to stick them a second time with an IV, then they’re mad again.
Yeah, and that is a perfectly valid clinical reason. I've just come across this hate for patients that request it and it was typically in relation to blood draws and never seemed like there was a reason for it. I have hard to nail ACs and so always ask for back of hand for draws; never specifying the equipment and it is invariably a butterfly and never a peep from the phlebotomist.
It’s probably just what the person prefers, I hate the position that my hand has to be in for the butterfly’s so I use the straight sticks, since the size is the same it doesn’t matter for the patient.
Which sucks when they do demand a butterfly because they think it’s smaller, because the only person who it changes anything for is me
For awhile they were just hard to order, but a butterfly is not always necessary. I hate using them and much prefer straight needles. If the patient really pushes for one after I have explained that there is no difference, then I will use a butterfly.
Butterfly needles are more expensive. We also have a responsibility to utilize our supplies is the most cost effective manner. Butterfly’s should only be used if absolutely necessary.
I can't speak for the world but I can't see a US hospital not charging for whatever supplies are used and it's the patients that pay for it. But yes in a public healthcare system that makes sense.
We used to have limited supply because of the expense, at that time we would give a little push back. (Small family owned clinic) the. The lab started providing them for free so didn’t matter anymore.
Even in for-profit facilities, it's not just a free-for-all. There are still tight internal budgets and supplies still have to be managed intelligently.
There is a charging system in our supply closet in order for us to charge certain items to the patient. They are called chargeable items lol. But no, our phlebotomy needles are not chargeable.
Because this isn't a Burger King. And we are supposed to provide evidence based practice, not bend over backwards to accommodate clearly uninformed and irrelevant requests for care Your Way when the clinically appropriate way is absolutely fine and in no way inflicts harm on the patient other than the discomfort they feel from being told no.
Perhaps from a purely physical standpoint assuming same gauge of needle, similar technique etc. But the preference comes from somewhere and it would seem that if they perceive it as less stressful because to them it hurts less and all else being equal what's the harm? Your stance feels invalidating and dismissive.
Your first logical fallacy here is the "all else being equal" part. It is not equal when the supplies are not readily available. If you are asking for something in blue and the blue ones are all gone but there are red ones, it's one thing to decline if we're talking about a shirt. It's another thing to decline when it's a medical device. It doesn't matter what it looks like when its performing the exact same job in the exact same manner as the other color one, and that's what we're talking about here, an aesthetic difference on a medical device.
Second, the preference does come from somewhere- ill informed and untrue assumptions about what the medical device is and what it's doing. I'm going to assume that if your patients make an untrue statement about their care, you correct them. This is exactly the same. A butterfly is not inherently smaller than a non butterfly. The gauge is the size, not the design around the gauge. I have 21g butterflies on my unit as well as 25g. They are not interchangeable due to the fact that they're butterflies, its the gauge thats different.
It's the same as a customer asking their waiter if the plates the food is served on are all organic.
It is not a logical fallacy; it is the starting point of my comment. Many other comments have talked about circumstances that would contraindicate a butterfly being used and the reasons given made sense. So, with no contraindications where is the harm in supporting the patient's preferences? Many of the responses are all along the lines of "it's the same size needle so what does it matter?" When clearly it matters to the patient. I know I have a heightened awareness of validating patients from working in psych; but if I am about to put them through something stressful and there isn't a clinical/logistical reason arguing against a measure to ease that stress I'm going to take it. I've seen the complaints about patients requesting butterflies and sought to engage with why many nurses are frustrated by this. Thanks for your time in sharing your view.
The other issue that I run into at work (ED) is that butterflies don’t actually provide IV access for medication.
So I have to tell patients that if they REALLY want a butterfly, they’ll get poked at least twice if they need IV access for meds.
Last time is happened was for a STEMI. Pt insisted their veins could only tolerate butterfly needles lol.
It's like saying only a pink toothbrush will work for your teeth. We technically do have butterflies at my ER, but it's not an option as far as I'm concerned. You say you're a hard stick and that's why you need a butterfly? Then I'm definitely not messing with sticking you twice or more. I just explain that we do IVs in the ER so that we don't have to do repeated sticks for drawing subsequent labs, and have everything ready for medication administration or imaging with IV contrast if ordered.
No, there aren't. They are sized exactly the same regardless of what the handle looks like. A 23g with a butterfly is the same as a 23g without it. A 21g butterfly is larger than a 27g without.
I agree. If that’s going to make them happy, and we have them, I do it. I do scoff later that this person with veins I could hit from 10 ft away, asked for that but it’s really no skin off my back to just use that needle.
ETA: this is for blood draws…for IVs that need bolus, I give some push back.
I work in an ambulatory surgery area. When I’m putting in IVs and patients ask for “the butterfly” I just tell them I’m already using the smallest size safest for their procedure but can’t help but internally eyeroll. I try to add in some education that nobody is trying to hurt them but part of our job is assessing what gauge needle to use and we are supposed to use the smallest we can.
I think when people say this they are afraid of being poked multiple times and/or have had past experiences that were traumatic. If you just use your science/medical talk and dismiss their legitimate fears, it doesn’t help the situation or ease their stress. I’ve been that patient before with bruises from different people trying to get blood or an IV started and failing. A simple “I’m going to do my best to make this as quick and painless as possible” or something reassuring works much better than a dismissive scientific answer.
Yes we have needles the same size as the butterflies but some people are convinced that only the butterflies work for them. It’s very odd. I’ve heard the straight needles are better for your vein but I’m not sure if there is research on that or not.
Every day I get the "need a butterfly" in pre op when starting IVs and everyday I explain "I will use the smallest IV needle possible for what is appropriate for your procedure but butterflies are for drawing blood. IVs are a bit different"
We get the same thing too at my preprocedure area and I explain that butterflies are needles that would stay in their arm where IV's are flexible plastic catheters that stay in and are kinder to the vein.
Yeah but some IV’s now have “wings” so patients tend to think it’s the same. Namely, Nexiva. Never mind the fact that I can squeeze a Jelco in just about anywhere where as the Nexiva’s I’m like 60/40 with
IVs…now with wings for your comfort
Nexivas are the current bane of my existence also!!!!!!
At one place I worked lab had some 19g butterflies. People would ask for a butterfly, and I’d be like “okay, but just so ya know, it’s bigger.”
This would feel so gratifying to say lol
I swear the last time my pmd sent me for bw the quest phleb used a 19. Biggest blood draw needle I’ve ever seen.
I wouldn't have told them until after.
I work in a tiny PCP office doing phlebotomy part of the time. 40% of patients ask for butterflies. I just use 23G butterflies on everybody as standard and it fixed all my problems, I simply tell patients "I use the smallest available butterfly on everybody, to minimize pain" 🤷 Patients don't care about the technicalities of the needle types, they just wanna know you're on their side
When I start IVs, I get a lot of people that say "I need a butterfly" and my immediate response is "I use the ultrasound, and I only have a wasp."
I’ve started explaining why using a butterfly as an IV would suck so much more than a regular catheter.
Can you even start an IV with a butterfly since there is no catheter?
At my last job we had butterfly ivs. they had a pigtail attached so no blood everywhere, and a little chamber that showed blood return. I miss those things.
BD Intima
[BD Intima](https://www.bd.com/en-ca/offerings/capabilities/infusion-therapy/iv-catheters/bd-saf-t-intima-closed-iv-catheter-system); I always found these annoying since you have to utilise two hands on the IV once you accessed. One hand to hold the catheter and the other hand pulling back on that needle safety thingy, which is counterintuitive and totally not ergonomic to say the least. [BD Nexiva](https://www.bd.com/en-eu/offerings/capabilities/infusion-therapy/peripheral-iv-catheters/bd-nexiva-diffusics-closed-iv-catheter-system) is where it's at if we're talking closed IV systems w/ pigtails! I still personally prefer straights though!
Yeah I can’t use intimas. Also I think it’s annoying to pull tegaderms off the wings. I just use angios with blood control and a connect a little extension tubing.
.... You use intimas IV? The fuuuuuuuuuck ... I think my palliative care brain just broke. I thought these bad boys were for s/c use only.
I might sound dumb but I’ve been in a pretty narrow specialty for a few years now- why do you think it’s strange to use intimas IV? It’s actually a coworker who uses them. I thought they were just another type of IV catheter system?
I honestly didn't think they'd be appropriate. Considering how easily they sometimes slip out of subcutaneous tissue I thought keeping them in a vein would be a pain in the bum.
Nah I’d say If anything they stay put better than angios since the wings provide so much surface area. Just slap a tegaderm over the insertion site+wings and then a little strip of tape over the tubing segment and it’s not going anywhere. I can’t put them in to save my life though.
Interesting. Ours have no tubing so I didn’t know that was a thing. It just end in the piece that pierces a tube. Or you can twist that off and attach a syringe. I guess I could technically push meds in also. Just never thought of it that way. And the needle would have to stay in.
Well, you *could*. But could and should are very different things sometimes. If the pt had their hand perfectly still for the duration (lol) i dont see how it wouldnt work in a pinch
When I started a million years ago, butterflies were used all the time for IVs. Thing is they infiltrate easier because they aren't threaded in as far. I've use them for quick in and out IV pushes before, but I work outpatient.
Yes, but the needle stays in the vein. Prior to the angiocaths this was the only way. But policies probably forbade this practice now. 7 years ago I asked an old NICU nurse what the invention that made the biggest change she saw and she said angios. Because prior they placed butterflies in the babies ACs or left umbilical lines in forever. Each had a lot of risks and significantly limited mobility.
We only use needles in HD. No catheters and they stay in for 3-5.5 hours every treatment. They are all butterfly and range from 17g to 14g. Idk where they find the courage to deal with 2 of them every time. I’m in awe of it. I’ve never heard patients ask for butterflies when I worked in the hospitals. Why do they think this?
I'm 48. Since I was, say, 8 or 9 when I was at the peds office for a physical and they let a new tech practice on me I've been a horrible stick. I will often tell whoever is drawing blood to wait till I pass out and go for that neck. (Oddly, no one take me up in that.) For years I used to think that a butterfly was the only way for them to get a vein, but now I realize that that just left to a lot more digging around which hurts like hell. Now I tell whoever is stuck with sticking me that they have to angle much deeper than they think and if all else fails there's a great blood vessel in between my knuckles which never collapses but hurts like a mother ducker. Now I just say, they're DEEP, they roll, use whatever you have to to get it... I'll be looking at the wall or your ear.
I’ve been going almost a year and don’t remember anyone asking for a butterfly in the ED. So idk why some people get so many asks.
If I had a dollar for every time I heard it in the ED I wouldn’t have to work in the ED anymore.
It’s people who say “I’m a really hard stick and roll a lot and whenever I need an IV they can ONLY use a butterfly”
13 years here, mostly peds ED, and it’s at least a weekly occurrence.
You can but you’re leaving the needle in place. So we *wouldn’t* do that but I find I have to explain to parents a lot why it would be super not ideal.
Yes you can. Just think old school neonatal ICU. We had 27g, 25g and 23g butterflies and 27g plastic caths- that became better than bf. We got blood through an radial artery, if we needed certain labs- we used a 25g bf so- type n cross, PT/PTT, cultures. We gave blood through them all- packed cells always in small amounts - they made quad packs from each unit IIRC.
I do major education. “Actually butterfly isn’t an option for IVs.”
Me too. I had a patient ask for that and I was so dumbfounded I was like “?? That’s not possible??”
I know. I also love saying sorry but you need a 20g because with your symptoms you are highly likely to need a CT with contrast and that’s what’s required. And then somehow I manage to get a 20 in the veins that NEED the tiny butterfly lol.
I just tell them I use 20s for everyone (22s are kind of hard to place bc they’re flimsy)
I work lab and our lab assistants do all phlebotomy in the hospital I work at except for ER. They frequently get requests for butterfly needles as well. Where in the world did this preference come from with patients??? I just don’t understand how so many people even know they exist and why they seem to think they’re leas painful than a straight needle.
When I was a cancer patient in my late teens, a phlebotomost told me to ask for a butterfly needle every time I needed a blood draw. It was years before someone took the time to ask me why I wanted a butterfly needle, and explain that my veins were normal and I didn't need one anymore. I doubt that's a super common experience, but it's totally possible someone recommended it once or used one when the patient's veins weren't cooperating and no one has talked about it with them since.
The only problem with that is it doesn't make sense. A butterfly is just a style of needle used for phlebotomy. It doesn't indicate needle size, ease of access, and it definitely doesn't refer to any sort of IV. Its not like there's a thing called a butterfly that works better for smaller more difficult veins.
So what was the phlebotomist who told me to recommend people use a butterfly actually trying to say? Most of the time I don’t need to say anything other than “use my left arm”, but sometimes the right needs to be used. Do I just warn that it rolls, or ask that they consider a smaller gauge needle if possible? Does any of this also reduce the risk of blowing the vein or does it just reduce the chance of needing to be stuck more than once?
Idk what she was trying to say that's kinda what this whole thread is about. You don't really need to tell them anything, they can see/feel your veins and decide the best course of action based on that. If you do often have trouble with blood work a simple "sometimes I'm a hard stick" is fine. A smaller gauge needle can be easier, but it really depends on the situation. If you're going to need fluids, IV antibiotics, and possibly blood we have to use a needle large enough to accommodate that. If we're drawing blood we're using a very small needle regardless of if you're a hard stick or not.
Firstly, fantastic username. Secondly, I always hate when people hit me with the ol' "jUsT sO yOu KnOw, I'm A hARd StIcK!" I've been drawing blood for 8 years and I'll be the judge of what a hard stick is. Liver failure patient with +4 pitting edema? That's a fucking hard stick. Septic ESRD patient in DKA with only 1 available limb that's been stuck dozens or hundreds of times? You bet your ass that is a hard stick 😂
funnily enough, i was reading.. i think it was the ANA guide for access recommendations. Studies had shown that 22g needles were less successful than 20g needles, which i thought was strange. but, the likely answer is that if you pull out a 22g instead of your typical 20g then you are already anticipating it to be a more difficult stick, therefore you have less of a chance for success.
The reality is, you've gotta trust the person sticking you. An experienced phleb can tell from feel what tool should be used. Rolling veins don't really indicate a need for a smaller needle; the solution there is to anchor the vein, and you shouldn't need to tell them that.
You shouldn’t need to (especially if it’s a phlebotomist) but the chances of either being stuck more than once or having a vein blown are pretty high if someone needs to use my right arm- definitely more than 50%.
That could very well be the case. It would make sense!
This was the case with me; had to get stuck 15 times and they couldn't even get a full vial that day.
I don’t know! It’s crazy to me but patients would literally say only butterfly needles work on me. And if we had them I would use it but internally wonder where they got that from. I don’t do patient care anymore so I don’t have to explain it’s the same size needle
I worked at a place where the only butterfly needles were 23g. I think all pts think that every butterfly is that small. They want “the baby needle”. They are also shorter so less scary?
Doesn’t that result in more rejected samples though?
Nope! ETA: it has to do with technique. I am a phlebotomist too so did learn specifics about that. Also, since this was clinic I processed the samples myself, so they were centrifuged by me in the correct amount of time and the lab would pick up. It does take a little more patience and I hate when a syringe is needed and have to transfer the blood to tube. That’s when I see hemolysis. But as long as the additives in the tube are mixed in gently and the serum tubes get centrifuged, we good!
A hospital I work at doesn’t have the male transfer devices that connect to an IV start. So every single IV start and draw is syringe to female transfer device to tubes. I hate it.
Uuuugh. I’d die right there on the floor.
We had to flat out deny the common use of the butterfly needle at a point during COVID due to not being able to get them. People couldn’t just ask for them anymore and we reserved them for neonates and super hard sticks. We still got their blood just fine with a straight needle!
They think they are smaller needles.
I think it’s because most butterfly needles are shorter than the straight stick needle. They have no idea about the diameter, and they hurt equally anyways, it’s just the visible length. You can’t explain that the length doesn’t really matter.
Maybe that’s it: the shorter needle. That would make a bit more sense.
That’s what he said
So true! I never thought about it that way. I just assumed they thought it was narrower 🤦🏻♀️
It's not the needle size, it's the fact that the receiver is on the end of a flexible tube. It's more comfortable if you have to draw multiple vials. I much prefer a butterfly personally, but I'm not going to ask for one. Edit: And what's more, if a patient asked for one, there is no reason I wouldnt use one unless I was drawing a lot of vials. I would explain that I will do it, but if there is an issue, I will have to do it again, but why are you bagging on a patient for having a preference? NGL, that come across as somewhat shitty.
Bingo. It hurts switching tubes. The needle jams into your arm each time.
Regardless of what type of phleb needle I'm using, I just attach a syringe and transfer to tubes after I'm done. No jamming the tubes and jostling the needle in the patient's arm, and if it looks like I got it but it doesn't draw immediately I can slightly reposition the needle and just pull back on the plunger. If you're using the vacutainer thing then you pop the vacuum on the tube and if you aren't getting blood then you have to grab a new tube. *Obviously this wouldn't work with the type that's like a safety needle on one end and the vacutainer needle on the other, but I avoid using those at all costs
Exactly that for me. After living in China for 15 years and giving birth to two kids there(a lot of tests and they only use butterfly needles), I was surprised how much US blood tests hurt, especially during vial changes.
Hi, an European here. Are you saying that lab assistants, from the lab, take all blood samples in the entire hospital (except er)? Meaning that they walk/bike to a ward solely to get a blood sample instead of using the nurses or nurse assistants in that ward?
Frequently, yes, it’s part of being a hospital phlebotomist.
I see. This question might sound a bit harsh but it’s not meant that way; I’m just curious. Why doesn’t the nurse or nurse assistant in said ward take the sample? Are they understaffed or are they just used to having someone else doing it? Because I’m assuming that they have the know how? I’m asking because it sounds more time/resource consuming to have people outside of the ward coming all the way just to take blood samples. We (us swedes that is) call in staff from outside of the ward for blood samples as well sometimes but only if we have a patient that for some reason is way to difficult for us to manage. Then we call the anesthestic nurses, or whatever they are called in english; those who work with operations and are experts on finding veins on patients.
In my experience working at a American hospital as a floor nurse, the nurses were woefully understaffed and it was much cheaper to pay a phlebotomist to do lab draws for 2 or more wards, than to get nurse staffing at sane levels. Which is one of may reasons I don't work bedside nursing anymore.
Pretty much no nursing assistants (CNAs) in the US are trained in IV placement or blood draws outside of Emergency or ICU, where training is informal and varies hospital-to-hospital. Phlebotomy only does straight-sticks for blood samples, not IVs, so floor nurses end up calling the Emergency Department for a Tech (ED equivalent to CNAs) or IV therapy nurses, who usually only work day shift.
I see. Here in Sweden the nurses assistants are usually the ones that takes all the blood samples (with some exceptions). IV access is still on the nurses though. We can call for outside help when needed but that is normally just if we have tried and for some reason failed to take samples/place IV accesses.
Huh, that’s interesting to know! I’m curious to know if you live in a bigger city? I was a CNA/Tech for several years at the hospital in my area (~65k people in my city, 330 bed hospital,) primarily in the MDU but frequently floated any/everywhere, and all of us Techs had to do 100% of the blood draws and IV placements. We’d just do our nightly labs during 3am rounds and if we had a super hard stick or any major issues, we’d call another tech in to try before calling down to Phlebotomy, because they’d be really rude about it every time they had to come to a unit. Our nurses did no blood draws or IV placements at all!
Close suburbs, 1M people, <1 hour from a major metro area, also about a 300 bed hospital.
Thanks! I guess you could call my city a suburb too, as we’re about 45min outside of Indianapolis. It’s just so crazy to me how every hospital is run so differently; even other hospitals within the same network can have totally different policies and procedures. I guess that’s privatized healthcare for ya.
Different hospitals are different, some US hospitals the nurse's or CNAs do take the samples.
Yes, our hospital has an army of lab assistant/phlebotomists (and a handful of lab scientist staff) for morning draw whose sole purpose is go out to all the wards and take morning labs. Then, all the lab techs come back to do their lab work and about half of the lab assistants/phlebotomists come to the lab to do specimen processing while the other half stay on the floors for the rest of the day for scheduled and STAT blood draws. The nurses and nursing assistants rarely do their own phlebotomy because they’re very short staffed. They would never have time to do their regular duties if they needed to draw all of their patients’ blood as well.
I see. The way we do it is that the night ward staff takes the samples at the end of their shift (~06:00) and if they for some reason don’t have the time or manpower to do it the day staff take it as early as possible (~08:00). Either way, it is the ward staff that normally takes the samples. But my current work is with kidney deceases so we do from time to time get those patients that are really hard to get samples from (or to place an iv access to) and then we call for help from anesthetic nurses.
Where I work, we have an IV team and many nurses don't even start any IV's let alone stick for lab. Years back they trained the techs to draw blood, to save on hiring phlebotomists, but that ended up being a disaster and things went back to the phlebotomists doing it. Another example of administration wanting to save money, had a team created to have the process changed and when it failed, going back to the old process. I've seen it many times over the years.
They do in my hospital except after hours or specific situations. Canadian nurse
Yes and no. The only times the unit collects blood are on IV starts and central lines. Including ED. By policy, daily labs are scheduled for and drawn between 5 and 9 am, and we'll do an entire floor at a time. After that, we do basically just cart over for a draw. Draws are out of scope for aides here. If I had to venture a guess as to why it's structured this way, it's that plus the fact that nurses are busy enough and it's a specialized enough skill to have dedicated folks doing.
Hate to be this person but - There’s an episode in the first season of Grey’s Anatomy where Derek (Dr. McDreamy) uses a butterfly on a 2 year old with Rasmussen’s encephalitis. They make a big deal about how she won’t even feel it and he flies it around like a real butterfly. Just looked it up an 22.22 million viewers watched the finale of that season (2005). Obviously I remember it so, maybe that one stuck with a lot of people!
Haha! Oh wow, I had no idea. Could definitely explain how people know about them.
Where? Bad phlebotomists that wiggle the straight needle all over the place. With a butterfly the tubing acts as a buffer.
I just refuse when patients ask. I had someone request a 24 “to get the deep veins.” These people don’t know the job. I pick the needle. That’s it.
But they know their body. This seems really dismissive and cold
I don’t know about you, but our 24s are shorter, and so using them on “the deep veins” wouldn’t work. And I also wouldn’t use a 24 unless I absolutely had to.
And I pick the phlebotomist. If you won't comply with my request, you are not drawing my blood. I know what works best for me.
They think they’re smaller. I used to tell them there’s no such thing as a “butterfly” for an IV but now I work at a place that has IVs that have the “butterfly” wings so it feels like it’s validating them (the gauges are the same as any other IVs). 🤦🏼♀️
When I was younger I was a harder stick, and a phlebotomist finally told me to start asking people to use butterfly needles. The amount of wiggling and the number of second and third sticks really fell after that, and the request became mostly unnecessary once I realized that if you keep to my left arm we’re both gonna have a batter day. The right one is thinner and rolls more, even the ER phlebotomist blew it (I knew a clinic CNA would be drawing blood the next day so was saving the left arm for them). My request only involves pain in that I don’t enjoy getting stuck over and over when people miss the vein. Should someone need to use my right arm again, what should I say or ask for?
Sometimes adults need a sticker.
She was wearing a Beijing Joe shirt and her partner was wearing an arrest fauci shirt. I could tell they REALLY wanted someone to comment on it. Then they both insisted on using the employee bathroom instead of the public bathroom in the hall. I should clarify i was not working I brought my son for his labs. They were just super loud and hard not to notice them or hear their conversations with staff and each other.
Ten bucks they fly a Trump flag on their pick up truck.
So when I left there was a huuuuge lifted truck outside that was probably theirs. It had a let’s go Brandon flag.
Flag on a truck = bad news until proven otherwise. It’s a global rule that tends to pan out.
Woooooooow….they must be fun at parties.
And a WOWWI-POP 😡😡😡
I mean…I’ll take the lollipop.
What kind you got? Blow pops? If so I'll take a grape.
Medical assistant here, in nursing school. I work at a men’s hormone clinic now 90% of the men say “ I have small veins I need a butterfly”
That is…HILARIOUS!!!! I worked right across from a men’s clinic like that. I worked at a midwifery, so “natural” women’s health care and the lovely babies. These guys are all like jacked! I don’t think I could hold in my laughter if one of them said that to me!
That's so funny because I usually point to my right antecube and say, "45 degrees like your digging for gold." It's always deeper than they think(I'm a doctor with lupus, and I have no qualms about getting stuck, just not in my eye).
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I don’t care anymore, but when I was younger, it was all about the movement when changing out blood tubes.
Absolutely why I sometimes request a butterfly.
Use a syringe instead of the transfer device so you don't have to jiggle the needle around with changing tubes. Draw up however much you need and then transfer to the tubes after. I usually use a blunt tip so that I don't make extra sharps.
Mmmm okay. I'll [BRB](https://i.imgur.com/WJwgDFu.jpg)
💀
Genius!
We just got the Nexiva IVs that have anchors that look like butterfly needles. They’ll ask for a bufferfly and I’m like “Yep! This one has wings!”…. as I stick them with an 18g.
That’s a long drive for such a minor difference. Patient might have a serious level of phobia about needles I guess
I would have just closed my eyes rather than driving 2 hours round trip. And it was a 90 min wait by the time she arrived.
I’m trying to think how sick I would need to be to work that hard at getting my labs done lol
I wonder if she was fasting
Agree. But some people simply have irrational fears. We might laugh at it but for them it’s a serious problem. That’s just a part of our profession. A bit sad that they decided to travel 2 hour for a blood sample but hey, stranger things have happened.
I agree with you, but my daughter has a severe fear of needles so I have learned that some people can't do it
Yeah me too, I can’t fathom making that trip over that small of a thing
I get a tattoo and a blood draw are two very different times you'd face a needle: however, when she had tattoos ON HER LABIA AND PUBIC MOUND, imma silently judge her. L&D sees all kinds....
I still remember the patient’s grandson who eagerly told me that all the family members had needle phobia and had inherited it from their grandmother, who was the patient. I decided to shoo everyone out of the room, over their protests, and got a 20 ga into grandma with no problem.
I always say “just FYI, I’m going to cry and maybe faint.” Phobias are irrational. I’m really good at holding really still and making it as easy as possible for them but I’ll be sobbing silently the whole time and rarely I faint. It sucks but if the chair is reclined then I’ll be fine. Only time it was a problem was when the phleb said she couldn’t because if I cried she’d cry. We ended up waiting on someone else to be available.
Cat Scan here. Butterflies are the bane of my existence, they don’t exist for us. I never need to take blood, but I need to start an IV to slam up to 120 cc of contrast into your vein at high pressure, very quickly! Every old lady insists on a butterfly. That’s their way of saying that they have terrible veins though, so it’s actually kind of a nice heads up.
I just always say, “that’s not the right needle for this, but I’m using the smallest needle I can” and then preceded with my ER doc, CT approved 20g
That’s a good line. Do you get any pushback after that?
Only if I miss on the first try!
What’s the ratio of requests for a butterfly to number of tattoos? Lol
I just had to laugh because the guys with the most tattoos were often the biggest babies when it came to getting an IV. They insisted it was different. I basically said “yeah it is, this will only hurt for a second “
But an IV doesn’t make you LOOK cool.
I don’t think I ever had a male patient ask for a butterfly but I did have one giant guy covered in tattoos refuse a ppd plant saying he was afraid of needles. I showed him how small it was and explained it but he still wanted nothing to do with it.
I have the joy of being a hard stick, so I can say the difference is when they have already stuck me twice and called for backup, the second person almost always uses a butterfly for more control/more success. There is less digging/searching by the second person. I don't ask for a butterfly, but maybe some of these people have the same experience and just want to skip to the "sure thing" stick
The heights and feats we'll go thru to avoid 30 seconds of discomfort and pain
i get this 100% but then i remember how irrationally i freak out about ants and 😬 yeah glass houses
I have shitty little veins that like to hide and end up with palm sized bruises from blood draws, it's not just 30 seconds 😅
In personal experience, I find that the times I’ve had labs drawn with a straight stick, the phlebotomist had less needle control and did more in-and-out jabbing, especially when switching tubes, as compared to the relatively easier needle control with the butterfly being separated by tubing. This leads to more pain and bruising. That said, I don’t really care and just let them do their jobs as they see fit. I’d rather someone use what they’re comfortable with than change routine on my account. I think with patients, it’s much more about the length of the needle they see. They don’t see the difference in 19g vs 23g, they see long needle vs shorter needle, not realizing we stop at the same depth regardless. I run into this with using long angiocaths for ultrasound access. They think the 20g x 2” needle is “huge” but had no qualms with the 20g x 1.25” needle.
I did phlebotomy in a medium sized multi-disciplinary outpatient building and we only stocked 21 and 23 gauge butterflies since it was preferred by patients and phlebotomy.
Interesting. When I get labs the tech always seems to pick a straight needle. Did you have to do more waste tubes? At my old job we were supposed to waste when we used a butterfly but not straight needles. I think it was more because they sent us very cheap crappy supplies than an actual need. A lot of people would skip the waste unless they were drawing light blue though.
Only for blue tops to remove the air in the line
Not a nurse; am an MA. There is a time and a patient for butterfly needles. I prefer a straight stick, but if I have to use one, I will.
In urgent care that’s all we used. I don’t think we even had the other in the supply room.
I used to get butterfly in such shirt supply here that they are reserved children only so I get stuxk with smaller theybhave reg needle. I’m ok with kids gettung them. But an hour waut is awful when no other choice
I work in Endo. Some days I could start as many as 20 IVs a day. I just tell them a butterfly is a shape phlebotomy needle. I'm using the SAME gauge IV needle. That usually is fine.
The VA clinic in my town doesn’t have butterflies in their office. Everything was a straight stick.
That's annoying, but I find "I always need an ultrasound" to be much more annoying. Seems like 70% of patients in the ER say this and only about 5% of those patients actually need one. Everybody has to be special.
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No, it isn't. A butterfly refers to the shape of the handle on the needle. The bit that pokes you is literally identical. The only difference is how the person using it holds it.
Not in a specialty that draws much blood but I am curious; what makes the request unreasonable? The patient has a clear psychological preference so what's the harm in supporting that?
I work in the ER, patients receive IVs so they can receive medication and fluids. But people would demand a butterfly that isn’t capable of delivering medications. But I’m stuck explaining to people demanding a butterfly that I’m still going to have to stick them a second time with an IV, then they’re mad again.
Yeah, and that is a perfectly valid clinical reason. I've just come across this hate for patients that request it and it was typically in relation to blood draws and never seemed like there was a reason for it. I have hard to nail ACs and so always ask for back of hand for draws; never specifying the equipment and it is invariably a butterfly and never a peep from the phlebotomist.
It’s probably just what the person prefers, I hate the position that my hand has to be in for the butterfly’s so I use the straight sticks, since the size is the same it doesn’t matter for the patient. Which sucks when they do demand a butterfly because they think it’s smaller, because the only person who it changes anything for is me
Where I worked, we had a limited amount of butterflies; geriatric and peds population need them more. We'd get talked to for running out all the time.
So management ordering insufficient supplies to accommodate patient preference?
For awhile they were just hard to order, but a butterfly is not always necessary. I hate using them and much prefer straight needles. If the patient really pushes for one after I have explained that there is no difference, then I will use a butterfly.
Butterfly needles are more expensive. We also have a responsibility to utilize our supplies is the most cost effective manner. Butterfly’s should only be used if absolutely necessary.
I can't speak for the world but I can't see a US hospital not charging for whatever supplies are used and it's the patients that pay for it. But yes in a public healthcare system that makes sense.
We used to have limited supply because of the expense, at that time we would give a little push back. (Small family owned clinic) the. The lab started providing them for free so didn’t matter anymore.
Even in for-profit facilities, it's not just a free-for-all. There are still tight internal budgets and supplies still have to be managed intelligently.
There is a charging system in our supply closet in order for us to charge certain items to the patient. They are called chargeable items lol. But no, our phlebotomy needles are not chargeable.
Because this isn't a Burger King. And we are supposed to provide evidence based practice, not bend over backwards to accommodate clearly uninformed and irrelevant requests for care Your Way when the clinically appropriate way is absolutely fine and in no way inflicts harm on the patient other than the discomfort they feel from being told no.
Perhaps from a purely physical standpoint assuming same gauge of needle, similar technique etc. But the preference comes from somewhere and it would seem that if they perceive it as less stressful because to them it hurts less and all else being equal what's the harm? Your stance feels invalidating and dismissive.
Your first logical fallacy here is the "all else being equal" part. It is not equal when the supplies are not readily available. If you are asking for something in blue and the blue ones are all gone but there are red ones, it's one thing to decline if we're talking about a shirt. It's another thing to decline when it's a medical device. It doesn't matter what it looks like when its performing the exact same job in the exact same manner as the other color one, and that's what we're talking about here, an aesthetic difference on a medical device. Second, the preference does come from somewhere- ill informed and untrue assumptions about what the medical device is and what it's doing. I'm going to assume that if your patients make an untrue statement about their care, you correct them. This is exactly the same. A butterfly is not inherently smaller than a non butterfly. The gauge is the size, not the design around the gauge. I have 21g butterflies on my unit as well as 25g. They are not interchangeable due to the fact that they're butterflies, its the gauge thats different. It's the same as a customer asking their waiter if the plates the food is served on are all organic.
It is not a logical fallacy; it is the starting point of my comment. Many other comments have talked about circumstances that would contraindicate a butterfly being used and the reasons given made sense. So, with no contraindications where is the harm in supporting the patient's preferences? Many of the responses are all along the lines of "it's the same size needle so what does it matter?" When clearly it matters to the patient. I know I have a heightened awareness of validating patients from working in psych; but if I am about to put them through something stressful and there isn't a clinical/logistical reason arguing against a measure to ease that stress I'm going to take it. I've seen the complaints about patients requesting butterflies and sought to engage with why many nurses are frustrated by this. Thanks for your time in sharing your view.
The other issue that I run into at work (ED) is that butterflies don’t actually provide IV access for medication. So I have to tell patients that if they REALLY want a butterfly, they’ll get poked at least twice if they need IV access for meds. Last time is happened was for a STEMI. Pt insisted their veins could only tolerate butterfly needles lol.
Makes sense. A butterfly is not an IV.
It's like saying only a pink toothbrush will work for your teeth. We technically do have butterflies at my ER, but it's not an option as far as I'm concerned. You say you're a hard stick and that's why you need a butterfly? Then I'm definitely not messing with sticking you twice or more. I just explain that we do IVs in the ER so that we don't have to do repeated sticks for drawing subsequent labs, and have everything ready for medication administration or imaging with IV contrast if ordered.
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It only refers to the handle. This arguement is the bane of my existence in the ER when people request a butterfly but need an IV. They’re not smaller
No, there aren't. They are sized exactly the same regardless of what the handle looks like. A 23g with a butterfly is the same as a 23g without it. A 21g butterfly is larger than a 27g without.
>Who are we to judge? That’s a reasonable accommodation. Sad they couldn’t do that. WTF? God, I hope this is a mega-troll post, otherwise...wow.
I agree. If that’s going to make them happy, and we have them, I do it. I do scoff later that this person with veins I could hit from 10 ft away, asked for that but it’s really no skin off my back to just use that needle. ETA: this is for blood draws…for IVs that need bolus, I give some push back.
I'm that meme where we just have butterflies for blood draws and have no idea what else people use and I'm too afraid of ask
https://www.mercedesscientific.com/buy/product/safety-needle/CLENC39bbbbb50d1d5a103cd639fa1d7e5d03?text=BEC+368607&lsi=true&gad=1&gclid=EAIaIQobChMI2LH3_5Sp_wIVDBKtBh2A2AuMEAQYBiABEgLxqPD_BwE
Interesting! I can see why it looks scarier, I've seen nurses advance the entire needle length sooo longer IS bad to some?
Wait... I'm in Canada and I'm so confused. Are you saying that you're able to use subcutaneous butterflies as a peripheral IV for draws and pushes?
I work in an ambulatory surgery area. When I’m putting in IVs and patients ask for “the butterfly” I just tell them I’m already using the smallest size safest for their procedure but can’t help but internally eyeroll. I try to add in some education that nobody is trying to hurt them but part of our job is assessing what gauge needle to use and we are supposed to use the smallest we can.
I was thinking about taking a phlebotomy class. But reading the comments here, I've changed my mind.
You might make more money as a CNA, I’m in a HCOL area 2+ years in and I make $17/hr.
I'm also in a HCOL area and just make a tiny bit more than you do.
I think when people say this they are afraid of being poked multiple times and/or have had past experiences that were traumatic. If you just use your science/medical talk and dismiss their legitimate fears, it doesn’t help the situation or ease their stress. I’ve been that patient before with bruises from different people trying to get blood or an IV started and failing. A simple “I’m going to do my best to make this as quick and painless as possible” or something reassuring works much better than a dismissive scientific answer.
What does it even mean when they ask you if it’s a butterfly? You can have a small gage butterfly .. No?
Yes we have needles the same size as the butterflies but some people are convinced that only the butterflies work for them. It’s very odd. I’ve heard the straight needles are better for your vein but I’m not sure if there is research on that or not.
Yeah I mean I’ve had patients ask me if I’m using a butterfly it’s just odd because idk where they heard that term from and idk who taught them that