Butterfly or No?

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EmtTravis

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So I was just wondering who prefers using butterfly caths vs strait caths. I know if you need to go large bore for trauma say either 16 or 14 you can't do butterflies. So what is your preference and why do you prefer the one over the other?
 
My philosophy is "if it'll fit it, stuck it". The larger bore the cath means they (manufacturer) have more metal to make the cath sharper. Sharper is better. Also the larger bore caths have thicker cathlon walls making them more stable. And that's in addition to the increased laminar flow of the larger bore.

If they need it then they need it. So if it'll fit it, stick it.
 
We don't even carry butterflies, so it isn't an issue for me.
 
We only carry straight caths, last time I used a butterfly was in the army but to be honest I don't notice a difference they are both tubes with holes in them.
 
Before I stopped hitting veins, I liked butterfly because of my big fingers. Also, they were on the BD sets that did not leak blood all over , you pulled the needle out of the cannula with a stylette which passed through a needle injection port. Problem was, too small a caliber for bigtime stuff.
 
MSDeltaFlt said:
My philosophy is "if it'll fit it, stuck it". The larger bore the cath means they (manufacturer) have more metal to make the cath sharper. Sharper is better. Also the larger bore caths have thicker cathlon walls making them more stable. And that's in addition to the increased laminar flow of the larger bore.

If they need it then they need it. So if it'll fit it, stick it.
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This is one reason why I normally reach for an 18ga cath first. It's going to be quite sharp and it'll deliver a good amount of volume if necessary. Of course, if the patient's veins will only take a 20ga... that's what I'll use.
 
I have only used butterflys for blood draws, everything thats going to stay in the patient is an angiocath. as for my go to size, 20 seams to be my favorite followed closely by an 18g. there is no point in me starting a 14 ever, the macro sets we have dont flow more than a 16g can handle.
 
socalmedic said:
I have only used butterflys for blood draws, everything thats going to stay in the patient is an angiocath. as for my go to size, 20 seams to be my favorite followed closely by an 18g. there is no point in me starting a 14 ever, the macro sets we have dont flow more than a 16g can handle.
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If my patient needs a 16ga, chances are pretty good that they need a 14ga. I've only had occasion to place a big bore line a few times, but most of the time, I "stick" with an 18... or a 20. I've noticed that the hospital IV RN's around here seem to like using 20 or 22 ga. I like the 18 just because it's kind of a jack-of-all-trades size in that you can get good flow, you can saline lock them, you can do lab draws pretty easily w/o hemolyzing the sample... and you can push D50 through it without too much difficulty. ;)
 
socalmedic said:
I have only used butterflys for blood draws, everything thats going to stay in the patient is an angiocath. as for my go to size, 20 seams to be my favorite followed closely by an 18g. there is no point in me starting a 14 ever, the macro sets we have dont flow more than a 16g can handle.
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Have You timed the 14's vs 16's vs 18's etc?

My pt will get the largest size they need that I can fit according to my assessments. You never say never and you never say always. Or else you're just limiting yourself; not to mention your pt.
 
Catheter length also plays a role in flow rate. If you ever wondered what a particular size will flow, it's printed on most pacakges.

If your referring to "winged" caths, I have no preference. If you referring to needle infusion sets, I'm not real keen of leaving a metal needle in the patient, particularly when they're often no smaller than a Teflon cath.
 
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Only use straight caths at work.

Have butterfly blood drawing needles on the volly bus. Don't prefer them.
 
MSDeltaFlt said:
Have You timed the 14's vs 16's vs 18's etc?

My pt will get the largest size they need that I can fit according to my assessments. You never say never and you never say always. Or else you're just limiting yourself; not to mention your pt.
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yes I have timed it, I have also talked with the baxter rep. the set we use flows 250ml/min our 16g cath (jelco protective plus) flows 230ml/min. if you have blood tubing I guess a 14g is appropriate for you. I was simply saying I have no need to ever start a 14g. however we don't use Y tubing, our hospitals don't even use special blood tubing.
 
A doctor or few have told me that unless you have access to transfusions in the very near future, the infusion rate of a 14/16g catheter can quickly turn into a mistake.

If a patient has lost 1/4 of their blood volume to a traumatic injury, a 14/16g isn't easily obtained for starters if vascular collapse occurs and in theory if we establish a pair of 14g IVs, we could infuse 500ccs a minute. How quickly do you think that would turn your blood into kool-aid?

If a tank of red liquid is leaking and we put clear liquid and pressure into it, we only force out the red liquid faster and make what remains diluted.

I work around a few of the busiest trauma centers in NYC and they rarely go bigger than 18g in the trauma room.
 
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We don't carry butterflys.. I've never seen them for anything other than blood draws on in the hospital.
 
I like butterflies for the fact that I seem to NEVER miss a stick with them... but have only ever used them for draws in the hospital. In the field, it's a normal IV, and usually a 20g.

I've been pretty crappy with IVs the past few weeks, but last week I actually hit every single one. Darn inconsistency.
 
Yea I've never missed with a butterfly and being a paramedic student I need the confidence lol. The fire dept where I do my ride time carries both strait and butterflies. I'm sure once my confidence gets up I start using straits more and more but as for now if the medics I ride with don't stop me when I reach for a butterfly i'll continue using them. And yes my go to sizes are either a 18 or 20. Most generally a 18 in case they need a CT.
 
socalmedic said:
yes I have timed it, I have also talked with the baxter rep. the set we use flows 250ml/min our 16g cath (jelco protective plus) flows 230ml/min. if you have blood tubing I guess a 14g is appropriate for you. I was simply saying I have no need to ever start a 14g. however we don't use Y tubing, our hospitals don't even use special blood tubing.
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NYMedic828 said:
A doctor or few have told me that unless you have access to transfusions in the very near future, the infusion rate of a 14/16g catheter can quickly turn into a mistake.

If a patient has lost 1/4 of their blood volume to a traumatic injury, a 14/16g isn't easily obtained for starters if vascular collapse occurs and in theory if we establish a pair of 14g IVs, we could infuse 500ccs a minute. How quickly do you think that would turn your blood into kool-aid?

If a tank of red liquid is leaking and we put clear liquid and pressure into it, we only force out the red liquid faster and make what remains diluted.

I work around a few of the busiest trauma centers in NYC and they rarely go bigger than 18g in the trauma room.
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Oh, I a big fan of permissive hypotension in the prehospital setting. I also believe in having large bore access, even if it is an INT, get that access. Because unless your receiving facility has capabilities of trauma lines, your hypovolemic trauma pt will need the laminar flow of your short 14's.

Get the access while you can when you can if you. Because waiting until the pt needs it (even on the way to surgery) is too late.

I'll start a 14G INT if I think my nonhypotensive pt is going to surgery and will/may need a lot of blood. Doesn't hurt me at all to stick them.
 
I've been told by the trauma center they prefer 14/16s if the pt is going to surgery and will need blood. 18s are ok, and they can give blood through a 20 if they have no other choice, but they don't like it.

We don't carry butterflies and I'm ok with that. What size I start depends on a few things. If it is an AC I almost always use an 18g because they are harder to bend than a 20g. Anywhere else it depends mostly on the pts veins and if they are getting fluid or if it is just a lock.
 
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Linuss said:
I like butterflies for the fact that I seem to NEVER miss a stick with them... but have only ever used them for draws in the hospital. In the field, it's a normal IV, and usually a 20g.

I've been pretty crappy with IVs the past few weeks, but last week I actually hit every single one. Darn inconsistency.
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I hear ya...I just lost my IV skills I think...
 
Carpal tunnel and c4-c5 compression robbed me of my stick talents. Limit those video games kiddies!

Not to advertise, but here's the brochure about the BD bloodless IV sets, and they make them up to 18g.

http://www.bd.com/infusion/pdfs/D14441.pdf
 
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