2025-09-29 – Weekly Phlebotomy News : Butterfly needles: To switch or not?

Last week in our phlebotomy community, members engaged in several meaningful discussions. There was a strong focus on career advancement, with many sharing insights on the expanding role of Phlebotomy Supervisors. The utility of butterfly needles for difficult veins was another prominent topic, sparking a debate on best practices for challenging draws. Practical workplace issues were also a hot topic, with conversations about managing the morning rush and calming nervous patients.


This Week’s Hot Topics

Weekly Phlebotomy Jobs: Phlebotomy Supervisor roles expanding
The discussion here centers on the growing opportunities for those looking to step into supervisory roles. It’s a sign of the evolving field and a chance for career growth.
Read more here

Are cover letters still worth it
We’re seeing varied opinions on whether cover letters still hold value in job applications. This could be crucial for those applying for new positions.
Read more here

Drowning in the morning rush
Phlebotomists are sharing strategies to manage the hectic morning hours more effectively, which could help improve workflow and reduce stress.
Read more here

Tiny tweaks that calm a nervous draw
Explore simple yet effective techniques to ease patient anxiety during blood draws, a valuable skill for maintaining patient comfort.
Read more here

Anyone else done with flimsy tourniquets
There’s been talk about the frustration with subpar tourniquets and how they affect daily operations. It’s a call for better equipment standards.
Read more here

Switching back to butterflies for tricky veins
This thread revisits the use of butterfly needles, with many sharing experiences and preferences for handling difficult draws.
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When the purple-top makes a break for it
A light-hearted yet informative exchange about dealing with the occasional mishap of escaping tubes.
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Low-pressure tubes saved a tricky draw today
Discussion on how low-pressure tubes can be a game-changer for difficult collections, sharing tips and experiences.
Read more here

Need CEUs that aren’t fluff (CA renewal coming up)
For those needing meaningful Continuing Education Units, this thread offers suggestions to meet renewal requirements without the fluff.
Read more here


Thanks for staying connected with us. Whether you’re here for career advice or practical tips, your contributions make this community a valuable resource.

For “difficult veins,” I’ll use a butterfly for shallow or hand draws, and if a blue-top is first, I always add a 3–[redacted] discard to fill the tubing so the citrate ratio stays right. They’re like training wheels — great when you need them, but not for every ride; anyone tracking hemolysis or underfill rates after switching?

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I’ll switch for shallow/fragile veins, but I pair the butterfly with a low-vac holder or syringe and a pediatric [redacted] blue-top to keep the 9:1 citrate right — fewer underfills than [redacted]… 2–3 minute warm pack before the draw beats digging and fits last week’s practical workplace issues focus, @bold-tracker41. I skip butterflies on easy AC veins since cost adds up and 25G bumps hemolysis; 23G only for me.

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I prewarm 3–5 minutes; fewer butterfly switches. Supervisors love the cost drop. You tracking it? https://apps.who.int/iris/handle/10665/44294.

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Quick tweak that’s helped me: let the forearm hang 20–30 seconds and release the tourniquet before you seat the first tube; often a thin‑walled 22G straight works and saves a butterfly — gravity’s free and rarely calls in sick. I still switch for hands or tiny targets. @beaver92 are you tracking hemolysis or underfills after these changes?

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On tough hand veins I’ll use a butterfly, but I pre‑tape the wings before attaching the holder so the angle stays flat and the vein doesn’t roll; if the vac tugs, I vent the first tube for a beat. @beaver92 do you secure the wings or anchor differently?

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I swap the tourniquet for a BP cuff around 40 mmHg on fragile forearms and go with a 21G straight — less vein collapse than a full vac, so butterflies become the exception. Ease the cuff down a notch once you see flash to limit hemoconcentration, and I’m curious if you’re tracking redraws vs supply costs on those sets, @Derek?

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I stick with a straight and swap to low‑vac (peds) tubes to soften the pull; after a 60–90s warm pack, that often makes “butterflies for difficult veins” unnecessary… @lgriffin30, have you tried low‑vac on fragile ACs? I still reach for a 23G butterfly with a syringe and transfer device when the wrist has valves or the patient tremors.

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With butterflies, if light blue is first I draw a small discard just to fill the tubing — prime it like a garden hose — so the citrate ratio and PT/INR aren’t off. @badger46 do you just clear the dead space or pull about [redacted]?

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And on the morning rush (), I’ve cut my butterfly use by grabbing the vein light and keeping my angle about 10–15° with a 22G straight, then releasing the tourniquet the moment I see flash — fragile ACs stay open without the extra tubing cost. WHO’s “Best practices in phlebotomy” backs the shallow angle/early release approach: https://apps.who.int/iris/handle/10665/44294; @lgriffin30 have you tried a transilluminator yet?

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