Venepuncture butterfly

In the hand,,,

Do you point the butterfly towards the fingers or towards the wrist ?

I think now you point the butterfly towards the fingers in the hand as blood goes distal -> proximal... but i used to do the other way before.

Anyone ? Cheers

Reply 1

ForestCat

18

Original post by Revenged

In the hand,,,

Do you point the butterfly towards the fingers or towards the wrist ?

I think now you point the butterfly towards the fingers in the hand as blood goes distal -> proximal... but i used to do the other way before.

Anyone ? Cheers

I always point the needle towards the wrist, same as if I am cannulating. I've never seen it done the other way. Would you not hit valves going the other way?

Reply 2

AnonymousPenguin

16

I have never thought about this, but I always point the needle proximally. Never had an issue. All the doctors seem to do it the same way here.

Reply 3

jooby92

2

I got a drop of blood on the patients bed when putting in a cannula the other day what should i have done like does the bedding need changed?

Also when taking blood today i went above a bandage that was covering his antocubital fossa as all his lower arms were unusable a drop of blood got on the top of the banadage would this banadage need changed? I juat put the cotton wool over where i punctured and it also covered the stain on his banadage so i just taped it there and left it but again not sure if i should have told the nirses so they would change the bandages or not

Reply 4

MHMQ786

Original post by jooby92

I got a drop of blood on the patients bed when putting in a cannula the other day what should i have done like does the bedding need changed?

Also when taking blood today i went above a bandage that was covering his antocubital fossa as all his lower arms were unusable a drop of blood got on the top of the banadage would this banadage need changed? I juat put the cotton wool over where i punctured and it also covered the stain on his banadage so i just taped it there and left it but again not sure if i should have told the nirses so they would change the bandages or not

If you make a mess you should definitely let the nurses know or they will be super pissed (depending on the nurse) when they see you left it without informing them.

Having said that, if it was just a drop then I personally wouldn't fret about it.

Reply 5

MHMQ786

Original post by Revenged

In the hand,,,

Do you point the butterfly towards the fingers or towards the wrist ?

I think now you point the butterfly towards the fingers in the hand as blood goes distal -> proximal... but i used to do the other way before.

Anyone ? Cheers

I have mostly pointed proximally (towards the wrist) when taking blood but there have been a few occasions that for whatever reason (patient can't move arm / tray in the way / awkwardly running vein) I have taken blood the other way and it has been fine.

Reply 6

jooby92

2

Original post by MHMQ786

If you make a mess you should definitely let the nurses know or they will be super pissed (depending on the nurse) when they see you left it without informing them.

Having said that, if it was just a drop then I personally wouldn't fret about it.

Yeh it was just one drop of blood on the bedding, it spread out to a circle of around 1cm diameter though, i wiped it with an alcohol wipe which prob juat spread it out a bit more ha but juat left it like that

Reply 7

Etomidate

15

Proximally. Never seen anyone do it distally.

Reply 8

Beska

21

Even if blood column is moving (or not, since you've put a tourniquet on) in the opposite direction to where the lumen of your needle is, I can't see physiologically it would make a difference. What you're relying on is the pressure difference between the venous lumen and the lumen of your blood collection device rather than hoping for any kind of mechanical effect from blood moving in a particular direction.

I think it would be more difficult to aim the needle distally, no? You'd have to stand behind the patient to point the needle down to their fingers, or contort your hand in some unusual way?

Original post by jooby92

Yeh it was just one drop of blood on the bedding, it spread out to a circle of around 1cm diameter though, i wiped it with an alcohol wipe which prob juat spread it out a bit more ha but juat left it like that

Might as well mention it. Just a "by the way, I took some blood from the patient in bed 7 and accidentally hit the bed with a few drops. I'm really sorry!" would probably stop them hating you. :p:

(edited 8 years ago)

Reply 9

Etomidate

15

Original post by Beska

Might as well mention it. Just a "by the way, I took some blood from the patient in bed 7 and accidentally hit the bed with a few drops. I'm really sorry!" would probably stop them hating you. :p:

Implying you could so easily find the nurse looking after said bay without spending 10 minutes wandering up and down the ward, poking your head into every cupboard, staff room, store room and sluice room.

Reply 10

Beska

21

Original post by Etomidate

Implying you could so easily find the nurse looking after said bay without spending 10 minutes wandering up and down the ward, poking your head into every cupboard, staff room, store room and sluice room.

Reply 11

Zorg

18

Original post by Etomidate

Implying you could so easily find the nurse looking after said bay without spending 10 minutes wandering up and down the ward, poking your head into every cupboard, staff room, store room and sluice room.

Just tell one of the HCAs/CSWs.
The number of times I got a *******ing from a senior sister because someone had spilt a drop of blood and not told anyone, pro tip: use a pillow or pillowcase under the pts arm/whatever is being accessed, pillow cases are far easier to change than sheets and the nurses will appreciate it :wink:

Reply 12

MonteCristo

14

Original post by jooby92

Yeh it was just one drop of blood on the bedding, it spread out to a circle of around 1cm diameter though, i wiped it with an alcohol wipe which prob juat spread it out a bit more ha but juat left it like that

If it was a tiny amount then, out of courtesy, I would ask the patient if they wanted me to find someone to change the sheets. They will probably say "no" but you don't want a complaint (from the patient or relatives) about "sheets left covered in blood".

If in doubt, let the nursing staff know and they can decide / speak with the patient.

Reply 13

nexttime

22

I have actually done that before if I'm going for a really small one and I think my needle will occlude the lumen (hence you'd get a small column of blood up to the next valve and then no more, in theory).

I am a long way from an expert though and haven't tried it enough to make any conclusions.

Reply 14

jooby92

2

Is it ok to always use a butteefly on the wards, i find them easier to use and u get flashback so knjw when ur in, but ive been told they are more expensive then normal blood collection needles so to not use them as much

Reply 15

Etomidate

15

Original post by jooby92

Is it ok to always use a butteefly on the wards, i find them easier to use and u get flashback so knjw when ur in, but ive been told they are more expensive then normal blood collection needles so to not use them as much

When the NHS is pissing away millions on obsolete computer systems, I wouldn't worry about it.

Reply 16

nexttime

22

Original post by jooby92

Is it ok to always use a butteefly on the wards, i find them easier to use and u get flashback so knjw when ur in, but ive been told they are more expensive then normal blood collection needles so to not use them as much

Sure, but if you've a higher success rate with them then you can justify it. Remember that even as an FY1 you're getting about £15 per hour - an extra 10 mins of your time is an extra £2.50, which will totally eclipse the difference in cost.

I believe butterflies also have higher needle-stick rates and higher levels of haemolysis/sample failure though. I do not know the evidence that's based on e.g. is it that difficult patients are done using butterfly, etc.

Reply 17

ForestCat

18

I think I am one of the few people who don't really like butterflies. I find I miss more/lose the vein halfway through far more than I do with a vacutainer and normal needle.

My university trust uses the monovette system and I am not sure I like it. Only done it on practice veins but it seems more of a pain than the vacutainer system.

Reply 18

seaholme

19

I've done it going the wrong way as in end of the needle pointing distally once when forced to... very septic old person with a single identifiable vein in a super awkward position (antecubital fossa in a stroked out arm that they would barely let me straighten!) in the dead of night! It did work for me, though I didn't get much out... hard to tell if it related to the method or the person though.

I always use butterflies. IMO it gives you greater feedback - when you're trying to stab somebody difficult and have to search for the vein, how else are you supposed to know you're there? o.O

Reply 19

Etomidate

15

I'm a butterfly man, myself. Although on elective they did have monovettes which were quite nice. But at the end of the day, you can't beat a 20mL syringe which you can then decant into vacutainers, gas syringes and culture bottles (naughty naughty). I also find it's less of a faff as you don't have to dock/remove vacutainers which jolt the needle around. Only really have an issue with haemolysis if it's a particularly small/slow vein.

Seem to get more haemolysis from cannulas though, especially anything less than pink.

Venepuncture butterfly

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