what am I doing wrong?

Whenver I insert butterfly needle to the vessel to draw blood it starts to form a big hematoma. what am I doing wrong? Last edit by Ms.RN on Oct 3, '11
Sounds like you are going in too far in or hitting the side of the vein. Either way, you are "popping" the vein. Don't go so deep next time. Watch for flashback and stop!

Also, remember NO fishing! Do not go in and out of the vein because the vein rolls or you are slightly off. Fishing causes trauma to the vessel. If you missed STOP and retry.

Look at the needle.......bevel up (one side is slanted and you can see the opening of the needle, face that up towards the ceiling) on insertion.

Are you able to get the blood draw??? If not your going right through the vein. If are able to draw blood.. no fishing or chicken feet..pressure, pressure, pressure after the the butterfly is remove. Do not have the pt bend his/her elbow to hold the gauze in place, this makes a pocket for the blood to pool on an AC stick. Have the pt hold their arm straight and you hold pressure for at least 30 secs and up to 5 min on comandin pts. Remove the tourniquet before removing the needle. Try to remove the needle in the same direct it went in, remember there is a sharp knife at the end of the needle that can cut alot of things on the way out. I have a problem with IM injection nicking the skin when I pull out.

May be your pt is old and don't do too well with tourniquetfind bigger vein (really, serious)

Sounds like you need some help before you really hurt somebody. Next time have another nurse step in with you to guide you through this process. Drawing blood should not be taken lightly. For one thing it hurts to be stuck, so please get some help if you dont feel comfortable.

Lower your angle when you insert butterfly to almost flat against the skin, advance slowly. The minute u see flash back put your vaccutainer on or use syringe to draw blood. Get the butterflys with longer tubing if possilbe. If you see flashback then a little gap, then blood, you probably blew the vein, if you attach the vaccutainer if may fill, but you'll see swelling, slow or fast. I try to stabilize the vein by stretching the skin taut, and use little or very loose elastic band. With pt's with little flashback (some brands are harder to see than others.) I will flush the butterfly and tubing with saline, draw a small amount in a waste tube, then get the sample. Release elastic band first, put finger gently on top of needle and slide needle out. Direct pressure applied by you, for at least 30 seconds. If your company doesn't supply coban, or (vet wrap) (that stretchy elastic stuff) buy your own, tell pt to leave on for at least 5 minutes. For larger viens AC I have learned to use a regular vacutainer needle in one of those plastic holders. It's a slightly higher angle of insert , just go in slowly and when you think you should be there, put on the vaccutube, if not, remove vaccutube and advance slowly a bit more, then same thing. I prefer bevel up.Organize and practice with your equipment and how you set up supplies on your own until you have an easy time with the fine finger movements and how to set up your supplies. Practice, I let people practice on me, it's not fun, but it's worth it to see, when someone is less nervous, how much easier it is. Also the person you practice on can give advice as you draw. I also would ask to follow a phlebotomy person around so you can observe and ask questions. If available I find it's easier at first to have someone to be your second pair of hands and give you your tubes, take them and hand the 2x2's alcohol etc. Also the IV Infusion thread on the nsg specialties has many threads on starting IV's drawing blood and they have great ideas. I've found a lot of helpful new hints there. Hope this is helpful and not redundant info.