2025-09-22 – Weekly Phlebotomy News : Butterfly needles for tricky veins?

Hello phlebotomists,

Last week on the forum, we saw a lively exchange on the evolving role of phlebotomy, especially concerning the integration of EKG skills in entry-level positions. Members also shared practical tips on tackling tricky draws, from using butterfly needles to managing patient anxiety. The conversation extended to professional development, with discussions on certification steps and the need for meaningful continuing education units, particularly for those renewing licenses in California.


This Week’s Hot Topics

The First Stick: Your Step-by-Step Guide to Becoming a Certified Phlebotomist
Explore a detailed guide that breaks down the certification process, making it less daunting for newcomers.
Read more here

Would You Take This Job? – Phlebotomy Technician
A candid discussion on the pros and cons of a specific job offer. It’s a great read if you’re evaluating new opportunities.
Read more here

Low‑pressure tubes saved a tricky draw today
Members share stories and techniques for using low-pressure tubes effectively, especially in challenging situations.
Read more here

Switching back to butterflies for tricky veins
Why some phlebotomists are revisiting butterfly needles for patients with difficult veins.
Read more here

Butterfly vs straight needle on busy mornings
A practical comparison of needle choices to streamline workflow during peak hours.
Read more here

Tiny tweaks that calm a nervous draw
Simple adjustments that can significantly ease patient anxiety during blood draws.
Read more here

Stiff butterfly tubing - brand switch worth it
Insights from those who’ve switched brands to solve tubing stiffness issues.
Read more here

Seeing more entry-level jobs bundling EKG
A trend alert: entry-level positions are increasingly requiring EKG skills.
Read more here

Need CEUs that aren’t fluff (CA renewal coming up)
Members seek out substantial CEUs for California license renewal.
Read more here

Notification badge won’t go away after clearing
A technical glitch discussion for those facing persistent notification issues.
Read more here


Wishing you all a productive week ahead. Keep those conversations going, and feel free to reach out with your own experiences and questions.

1 Like

With butterflies on fragile veins, I start with a pediatric low-vac tube to keep the vacuum gentle and prevent collapse, then swap to standard once the flow is steady β€” saved me a lot of redraws; anyone else do this?

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I pre-warm 2 minutes and release tourniquet on flash; 23G butterfly, 10–15Β° angle. Anyone using NIR?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ β€‹β€‹β€Œβ€β€β€‹β€Œβ€β€β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€Œβ€Œβ€‹β β€Œβ β€‹β β€β€‹β€‹β β€Œβ€‹β€‹β β€Œβ β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€‹β€‹β β€β€Œβ€‹β β€‹β€β€‹β β€Œβ€‹β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€β€β€Œβ€β β€‹β€Œβ β€‹β€Œβ€Œβ β€Œβ€β€Œβ€β€β€‹β€Œβ β€‹β€Œβ€Œβ€β€β β€Œβ€‹β β€‹β€Œβ€β€β€β€Œβ β€‹β€Œβ€‹β β€‹β β€‹β β€‹β€β€Œβ€‹β€β β€Œβ€Œβ€‹β€β€Œβ€‹β€β€Œβ€Œβ€‹β€β β€‹β€β€‹β€β€Œβ β β€Œβ€‹β€‹

I get fewer collapses by swapping the tourniquet for a BP cuff around 40 mmHg draws and lowering the hand below heart level for about 30 seconds before the first tube β€” gentle pressure, not a chokehold. If policy allows, it pairs well with a butterfly; @LabDerek, have you tried this alongside NIR?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ β€‹β€‹β€Œβ€β€β€‹β€Œβ€β€β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€Œβ€Œβ€‹β β€Œβ β€‹β β€β€‹β€‹β β€Œβ€‹β€‹β β€Œβ β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€‹β€‹β β€β€Œβ€‹β β€‹β€β€‹β β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€‹β€β β€Œβ€Œβ€‹β β€Œβ€β β€‹β€Œβ€‹β€Œβ€Œβ€Œβ€Œβ€β€β€Œβ β€Œβ€Œβ€Œβ€‹β€β€‹β€‹β β€‹β€β€Œβ€‹β β€Œβ€Œβ€‹β β€β€‹β β€β€‹β€Œβ€‹β β€Œβ€Œβ€‹β€Œβ€Œβ€‹β€β β€Œβ€Œβ€β€Œβ€‹β€‹β β€‹β€‹β€‹β€β€‹β€β€Œβ β β€Œβ€‹β€‹

One thing that saves re-sticks: with a butterfly, β€œuse a discard before the blue top” so the citrated tube isn’t short β€” attach a small non-additive/red first to clear the tubing dead space. If it’s not a coag draw, skip the discard to spare volume. Anyone validated the minimum discard volume for your sets?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ β€‹β€‹β€Œβ€β€β€‹β€Œβ€β€β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€Œβ€Œβ€‹β β€Œβ β€‹β β€β€‹β€‹β β€Œβ€‹β€‹β β€Œβ β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€Œβ€‹β β€‹β€‹β€‹β β€‹β€‹β€‹β β€‹β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€‹β€Œβ€‹β€Œβ€Œβ€‹β€‹β€Œβ€‹β€β β€Œβ β€Œβ€β€Œβ€Œβ β β€Œβ€Œβ€‹β€‹β€‹β β€‹β€‹β€Œβ€Œβ β β€Œβ€‹β β€Œβ€Œβ€Œβ€‹β€‹β€Œβ€Œβ€β€Œβ€Œβ€‹β€Œβ€β€Œβ€‹β€β β€‹β β€‹β€Œβ€Œβ€‹β€β€β€Œβ€Œβ€β€β€‹β€β€‹β€β€Œβ β β€Œβ€‹β€‹

I’ve had better luck on fragile, rolling veins using a 25G butterfly with low‑vacuum pediatric tubes β€” reduces collapses without moving to syringes. Fills are slower and hemolysis creeps up if you β€œmilk,” so I stop early if flow dips; would love to hear if low‑vac has changed your redraw rate with NIR, @jay4414.

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ β€‹β€‹β€Œβ€β€β€‹β€Œβ€β€β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€Œβ€Œβ€‹β β€Œβ β€‹β β€β€‹β€‹β β€Œβ€‹β€‹β β€Œβ β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€Œβ€‹β β€‹β€‹β€‹β β€‹β€‹β€‹β β€Œβ€‹β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€‹β€‹β€β€‹β β€β€Œβ€Œβ€‹β β€‹β€‹β β€Œβ€‹β€‹β β€‹β€Œβ€Œβ€‹β β€β€Œβ€β€Œβ€Œβ€‹β β€Œβ β€Œβ€‹β€Œβ β€‹β€β β€Œβ€Œβ€‹β β€‹β€Œβ β€‹β€‹β€Œβ β€‹β β€Œβ€β€β€β€Œβ β€β€‹β€Œβ β€Œβ€Œβ€‹β€β€‹β€β€Œβ β β€Œβ€‹β€‹

On tricky rollers, I confirm flash with a 23G butterfly, then tape the wings down before clicking in the first tube so the vacuum doesn’t nudge the tip β€” this alone has cut my collapses and wiggles a lot… If flow fades mid-tube, briefly back the tube off the holder and re-seat to bleed a touch of vacuum without moving the needle. @jay4414, has NIR plus low‑vac lowered your redraws?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ β€‹β€‹β€Œβ€β€β€‹β€Œβ€β€β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€Œβ€Œβ€‹β β€Œβ β€‹β β€β€‹β€‹β β€Œβ€‹β€‹β β€Œβ β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€Œβ€‹β β€‹β€‹β€‹β β€‹β€‹β€‹β β€Œβ€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€β€Œβ€Œβ€Œβ€β€‹β€Œβ β€Œβ€β€‹β β€‹β β€Œβ€β€‹β€Œβ€Œβ€‹β€β β€Œβ€β β€‹β€Œβ€‹β β€Œβ€Œβ€β€‹β β€Œβ€Œβ€Œβ€‹β€Œβ€Œβ€β€‹β€Œβ€‹β€Œβ β€Œβ€β€‹β β€Œβ€‹β β β€‹β β€‹β€Œβ€Œβ β€β€Œβ€‹β€β€‹β€β€Œβ β β€Œβ€‹β€‹

On tiny, drifty veins I use a two‑point anchor and keep the butterfly almost flat; after you see flash, β€œdrop the angle and advance 1–2 mm” before seating the tube so recoil doesn’t pop you out. If the vein’s temperamental, a warm pack for 2–3 minutes beats changing gauges, and WHO’s Best Practices backs warming: https://apps.who.int/iris/handle/10665/44294. Anyone else see fewer collapses when you leave a small slack loop in the tubing so the holder’s weight doesn’t tug?

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I make a small loop in the butterfly tubing and tape the loop to the arm before the first tube β€” β€œloop‑and‑tape” works like a seatbelt so the vacuum tug won’t nudge the tip. Skip if the skin’s fragile; do you pair this with a warm pack or a transilluminator, @jaca984?

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