Blood test in A&E - is this standard?

[isthereaway]

YP needed 3 blood tests in A&E on Fri. Dr used needle with clear 'butterfly' shaped piece directly below needle but but blood was then drawn via needle through a very narrow flexible tube about 3/4" long before going into the standard receiving tube.
Only 1 vial was obtained, & even after quite a lot of needle waggling, 2nd & 3rd attempts in different sites no more blood was successfully drawn. Dr then divided the blood from 1st tube between 3 & said; 'hope thats enough'.
Thinking about it after, I don't remember this long thin tube before?

Depending on why they were in ED, the difficulty in getting a good sample may be more to do with what was going on for the young person than the collection method. If they were a bit dehydrated or cold, they may not bleed as well.

As to why butterfly was used. Possibly clinician experience or preference, possibly the hospital trust protocols. As many have said on here many people have a better experience with a butterfly needle.

The young person can express a preference if they need bloods again. That will be taken into consideration but the same technique/equipment may be used again if the clinician thinks it’s the most appropriate for the situation.

I rarely use anything other than these as most my patients are difficult to bleed and these seem to give us a much better success rate. I have never had one 'block'. It's more likely that the vein collapsed. Also they shouldn't be mixing or underfilling the tubes.

JennieTheZebra - thank you this is very helpful to know. It was a (?student; wearing a local Uni badge on uniform) Dr who said she was on 2nd ever rotation (1st was paediatrics). She was lovely, very chatty but really nervous: dropped a few things. Needle was wiggled around a lot & re-sited twice, (both inner elbows & hand) but only 1st draw worked. Bloods were for troponin, inflammation markers & electrolytes. 2 hrs later we were told there was not enough blood to test so & sent home. Appt made to 'come back Mon @ 10' as not enough staff on until then.

Did they use the same butterfly for all 3 goes?… blood will have just clotted in the tubing if they did.

Yes it's fine re butterfly. Though it's not foolproof you need a decent vein for good flow in the butterfly tube. The tube wasn't blocked just the blood stopped flowing as it wasn't a good flow.
Swapping the bottles over at the end of the tube is normal, but I wouldn't open a filled bottle and tip blood into another as most contain fluid reagent appropriate to that bottle.

One needle. First tube filled (very slowly). 2nd didn't so needle moved to 2nd inner elbow. Filled maybe 1/10 of tube then stopped. Moved to hand. Filled 1/10 of 3rd tube then stopped. Both YP & Dr stressed by this point. Dr opened 1st tube & shared blood out between the 3 tubes & said: 'prob not enough, will send off & see'.

I have this when my veins are being tricky. Has happened when I'm ill and dehydrated.

I prefer using the butterfly needle when I'm taking bloods.
Did they use the same needle for the 3 areas though as that's not ok.

A needle should only be used once. It can be dangerous to reuse the needle I.e if they have taken it out and put in another vein that is very wrong.

I don't think you can open the blood collecting vacutainers & if you could you wouldn't be able to close them again.

On the face of it, it sounds like bad practice. There are a couple of red flags, including the fact that they didn’t seem to introduce themselves properly so you don’t really seem to know who they were or whether or not they were actually qualified (!). Were there other staff around keeping an eye on what was going on? It does sound like mistakes were made…

Yes you can.

Assuming the blood test is tomorrow make sure YP has enough to drink tonight /tomorrow morning, and keep arms /hands warm. As a previous regular blood donor all these things helped make sure my veins were full of blood that came out quickly.
Good luck.

No real issue except tipping from one into the other bottles - unless it was a pink bottle.
I'm not a huge fan of butterflies they can be temperamental with thin veins but they are handy at times

@Greybeardy I mean I've never tried opening one but just assumed as they are vacuum sealed then I couldn't.

You can take the lids off the bottles if needed .

Yeah, you can (at least with the brands I've seen) pop the top off if you need to. But you can only pour out of a plain tube into other tubes, not the other way round. And you definitely don't reuse a needle. Personally I much prefer a butterfly to the needle that attached to vacutainers, but then I'm generally taking blood from children's hands, not adults antecubital fossae.

In fact for tricky bloods we use needle / syringe or if take via syringe from cannula, you open the bottles.

I never use the shirt vacationers the Phlebs use- horrible things.

I had blood taken this way in my last pregnancy. I have terrible veins anyway but I was developing preeclampsia, having bloods every 3 days and after 3 weeks, nothing was working. They did the dividing blood between the different vials as well and on that occasion I also got told that not a large enough sample had been supplied and had to go through the whole process again 😫

In that case no that’s not right then, equipment yes but needle should be used once then thrown away. They can become blunt and risks infection from skin to bloodstream and is an absoloute no!

You have to start again with a new butterfly anyway because it could clog or if the bottle still attached there'll be no new suction.

The bottles don't attach to the butterfly, you use a syringe. But obviously need a new butterfly for each attempt for both hygiene and clotting reasons.

The bottomed attach to the vacationer bung too

Bottles attach to the vacationer bung thing.