It seems to me that twisting something around inside the vein would do a lot more damage, and be more painful, than just sticking it straight in.
That picture makes it look like bevel down is a lot better, but don’t trust it. The angle of the line that bisects the tip angle is about 10 degrees from horizontal in the “bevel down” case, and 30 degrees or so for the “bevel up” case. Why? Because he drew it with the axes of the needles parallel.
But why does that have to be the case? It doesn’t. The “bevel up” image is much more vertical than it needs to be. It could be made much closer to horizontal. The “bevel down” case can’t be made more horizontal. The bevel is already parallel to the surface of the skin.
Make the angle of the tip the same in the two cases, and the resulting image won’t seem so definitive. When penetrating the skin, they’ll both penetrate equally as deeply before hitting the back of the vein. But “bevel up” will have its opening better angled into the vein.
Now maybe bevel down is better, but you need more than a sloppy drawing as a basis to switch how you’re injecting a needle. Even the author’s personal history isn’t convincing to me; it’s just one person. Like he says, maybe it’s just due to his level of experience.
Oh, and fredmeister, that same link was in the OP.
Slow down. First, nothing personal, but anybodies *belief *in revolutionizing venipuncture doesn’t mean shit to me. Second, I read the link before I posted the first time and it’s pure annecdote. Separating his bevel choice from the craft of years of experience is not easy and he doesn’t even try. Additionally he makes other statements which are not consistent with my experience, which includes thousands of venipunctures. Third, I already have an amazing reputation for hitting hard sticks, and fourth, I did a google before and came up empty.
So, if you have some cites, I’d love to see them, if you’re going with some annecdotes and ‘it makes sense’, that’s fine too, but I’d ask you to tone down this kind of rhetoric
It’s obvious that nobody has looked at the diagram posted on the link provided in the original post! It is also rich with information and positive results data!
ROTATE is a better word than TWIST (synonym). Surely you should be able to see that ROTATING the needle about its own axis would produce neglible movement as long as you stay on the axis.
In any event you guys need to GO CHECK OUT THIS LINK !!!
===> http://dinosaurmusings.blogspot.com/...evel-down.html
======== DO IT NOW !!! =================>>>
fredmeister …
Ok, you win…
You’ve seen the link aint worth poop!
Happy hematomas…
:rolleyes:
I’ve started thousands of IV and probably done twice as many butterfly draws, and there can be times bevel down seems to work slightly better, but only when placing an IV. An much older and wiser nurse/medic showed it to me as a simpler way of hitting very flat veins, especially if you are trying to place a larger bore IV: 14-18 gauge. Most often, IV angiocaths have a central needle, with the metal piercing extending very slightly past the catheter that will be advanced over the end and left in the patient.
The picture shown initially might be a better understood to have “skin” replaced with “tunica externa”, showing how you can get a flash (as soon as any part of the needle edge enters the lumen), but still not have the full circumference of the angiocath passing through the vessel wall- in the first “bevel up” picture, it would be setting right at the skin/tunica externa line. In patients with weak veins, advancing the angiocath at that point would likely cause a small tear, maybe blowing the IV attempt or just causing a nasty bruise/hematoma. By flipping the bevel upside-down, you know that once you have entered the lumen (by feel or by flash) it’s safer to advance the catheter.
I can report I have had luck with this in patients with severe septic shock, traumatic hypovolemia situations and in some older patients with very weak vasculature, often when they had received multiple failed attempts- I assume bevel up. I think it helps when a patient is bottoming out on their pressure and they just don’t have the cardiac output to properly fill their veins like normal.
With all of that said, I don’t think I’ve ever gone bevel down while simply drawing blood, because the mechanics of that action are different from starting IV’s- you aren’t introducing a catheter, smooth blood flow is important for not lysing RBC’s and I would worry about applying suction when the bevel is parallel to the far wall of the vein. Normally, when starting an IV or drawing blood, the most important concern for the patient is minimizing pain, so I would introduce the smallest/sharpest point of the needle first. I definitely wouldn’t claim bevel down is going to revolutionize venipuncture.
Right, because there’s no possible way that people critiquing the details of that very diagram could possibly have seen it.
… you lost me… are you saying it was inaccessible? I don’t understand your post.
OP: Drawing blood: Which way should the needle be oriented?
Pointy part toward the patient.
Today when I first posted to this thread it had been dormant for about 2 1/2 years.
It had originally 10 posts over 3 days. Today we have had at least that many in 1 day.
If nothing else I hope to have brought some focus on the subject of drawing blood and I admit to a certain amount of hype and drama in my rhetoric.
My total qualifications are that I have been on the receiving end of needles continuously sticking me and probing, and fishing, and bruising my arm.
Yesterday as one of you experts was preparing to stick me yet again I suggested that the phlebotomist insert the needle with the “flat part” down. (Today I learned that the “flat part” is called a bevel.) Naturally the phleb was offended and insisted on sticking me with the bevel up. Next thing I noticed was that the phleb rotated the bevel down and immediately got a spurt (or as I learned later a “flash”).
I was so relieved with the experience that I was prompted to Google for “needle angle” to see if I got any hits. I ended up on the Straight Dope Msg Board because it was the only place that addressed the issue of a bevel down insertion. (albeit 2+ yrs ago)
So maybe “bevel-up-and-rotate-to-bevel-down” won’t revolutionize phlebotomy. Maybe it’s just the Morphine talking. But I hope maybe somebody got something out this blog.
Chalk it up to alternative techniques or whatever. I was only trying to help and maybe add to somebody’s knowledge base. Who knows I might even get somebody to stick me right in my future. If the guy in the referenced link could draw blood from tiny quail wings with this technique it stands to reason that it might work for bigger veins.
Keep up the good work all you Venipuncturists.
Remember: “Pointy part toward the patient.”
fredmeister
61-yearold Pin Cushion for Venipuncture Trainees
So, if I can sumarize, you’re spinning 180 on people with floppy veins after the flash but before you try to advance the catheter? I can see that, I think I’ll try it.
It was sarcasm. You complain that people obviously haven’t looked at the diagram, right after a post by someone who’s describing details of the diagram.
Outlierrn… Thanks for seeing the possible benefits of the 180° spin technique when performing a venipuncture.
I feel like I have accomplished my mission to reduce pain and hematomas for the pt.
Regards,
fredmeister
What pain? I’ve gotten stuck in the arm many times, by people using the conventional orientation with no twisting, and it really doesn’t hurt.
I am a religious blood donor… and I just had my blood donation today. For all the years that Im being punctured by a gauge 16 needle I find it more painful and with a more visible scar for a bevel down technique. The personnel doing the collection in our Hospital is using the bevel down technique and its my 3rd time being with her. I never had a pleasant experience with it and I told her about my concern and how I compared the experience of this bevel technique. She implied that she will do the bevel up on my next visit which is 3 months from now. I personally prefer the bevel up it is less painful and with a less visible scar left on my arm. I will update here if my theory is right.
Didn’t read the OP, but I think the answer is: pointy end toward the patient.