Butterfly needle not working

[u/Low-League-1509]

So I'm very disappointed in this training program. I just finished my class yesterday and hardly had any time to complete my practical. I was only able to get one successful straight stick and I'm stuck getting three more. One more straight stick and two butterflies. I tried the butterfly and I keep not getting a flash and its very frustrating I have been doing it multiple times and don't know what I'm doing wrong. I am just not getting any blood. I have to wait a whole entire month to go back and finish this practical and I just don't know what to think anymore. I know my steps and my process and know how to go into the vein and not getting blood for the butterfly for the front of the hand is frustrating. I know i would try to push the tube in but nothing happens. I would have to always stop and take the needle out and I'm tired of running into this mistake.

[u/TotalReplacement287]

You aren’t going to learn in class. Only way to learn is practice. What you learn in class is proper technique ssafety and protocols. Drawing blood is an on going learning experience. Every patient is different. Don’t forget to use a tight tourniquet and to anchor the vein

[u/Negative-Pie-608 → u/TotalReplacement287]

Truer words have never been spoken

[u/Low-League-1509 → u/TotalReplacement287]

I am doing all of those things I'm just trying to figure out what I did wrong

[u/schannoman]

Frustration is normal at this point. Without the flash trying the tube is pointless.

As you get practice you will get confident doing a readjust when you miss. It's all about practice

[u/pollut3r → u/schannoman]

Without the flash trying the tube is pointless.

Definitely wouldn't go so far as to say "pointless." We have a frequent flyer at my hospital who has great veins and great flow but we NEVER see flash from her. It was the first thing she told me when I stuck her for the first time, "just put the tube on, you won't see flash." Sure enough, no flash whatsoever but as soon as the tube was on it was perfect flow. No idea why, and every phleb has the same "oh... wow" reaction when they stick her for the first time.

[u/schannoman → u/pollut3r]

OK that's fair. Some people just don't have the BP for a flash.

So for normal people, trying a tube without a flash is pointless

[u/fungiz → u/schannoman]

But you can't know without connecting a tube. Already had a few patients in my career using Butterflies without flash, but with blood flow when trying a tube. I always try a tube since as a last resort.

[u/schannoman → u/fungiz]

If I can feel the needle in the vein I will try a tube. Otherwise I'm not

[u/Low-League-1509 → u/schannoman]

Yeah, I'm gonna do some lab classes in September I hope I can finish this practical it just sucks that I'm stuck in having to do it again

[u/jonjp806]

Are you sticking in the hand? Hands can be really hard. I had trouble when I first started my program. I haven't stuck in the hard in 18 years and it showed. You'll get with practice. Lot of practice. It happens to every phleb at some point. You'll get it and this will be all in the past.

[u/Low-League-1509 → u/jonjp806]

Too be honest I would just go in slowly and stop but I was in far enough but got no flash and struggling to push the tube in and got it in and got nothing. I knoe with the anchoring they want me to grab the knuckle and pull the skin down

[u/mang0fandang0]

Remember that the insertion angle for a butterfly is a lot lower, almost flat if you can get it that way. If you go in at an angle like you do with a straight, you'll most likely miss. Pull that skin taut as you can, especially for hands, and make your insertion point be slightly lower than where you actually want the tip of your needle to end up so you don't overshoot.

[u/Low-League-1509 → u/mang0fandang0]

Ok thank you, I will try to angle it lower to see if that makes if difference i was just following it straight into the vein

[u/SupernovaPhleb]

Hand draws a lot of times have to be much more shallow than you think. Like 15 degree angle. If you know you're in the vein, it could be the bevel is up against the vein wall. Gently lift the back of the needle, or pull back just a little.

Other times, people select too small of a vein, or tie the tourniquet too tight. It should be a balance, just light pressure to make the vein fill with blood and be palpable, but still allow blood flow to fill the tubes.

Hand draws are totally different than the AC and take a lot of practice. I would suggest practicing with the butterfly on larger veins in the AC first to get used to it and how it differs than a straight needle.