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Butterfly IV administration

  • 1.  Butterfly IV administration

    Posted 05-14-2019 11:51



    I am pretty sure I read somewhere that using a butterfly set for chemotherapy administration is deemed unsafe.  Looking for any feedback, something in writing would be great.

    Please advise, thank you in advance.



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  • 2.  RE: Butterfly IV administration

    Posted 05-15-2019 07:29
    ​Hi, Shannon

    The ONS Chemotherapy and Biotherapy Administration Guidelines book says to use a "peripheral catheter". If I understand correctly, this is because steel needles do not flex and can be easily dislodged, perforate the vein wall.

    Rae Norrod, MS, RN, AOCN, CNS
    Manager, Cancer Support Services
    Kettering Health Network
    Kettering, OH

  • 3.  RE: Butterfly IV administration

    Posted 05-15-2019 11:45

    Rae is correct, steel winged "butterfly" needles are more rigid and considered a risk factor for peripheral extravasation. This is stated on page 252 of the new Chemo/Immuno Guidelines text. In addition, the Access Device Standards text also discourages the use of steel needles for administration of medication which can cause tissue necrosis if extravasation were to occur (page 28). Hope this helps!

    Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS
    Oncology Clinical Specialist
    Oncology Nursing Society

  • 4.  RE: Butterfly IV administration

    Posted 05-15-2019 12:01
    According to ONS Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice 2019:

    • "Avoid the use of metal needles, as they may increase the risk of infiltration or extravasation." [page 212]
    • "Risk factors for peripheral extravasation (include) use of rigid IV devices (e.g., steel winged 'butterfly' needles)." [page 252]

    Anne Moser BSN RN MPH
    Tulsa OK

  • 5.  RE: Butterfly IV administration

    Posted 05-16-2019 20:54
    Hello. We are currently using a butterfly peripheral IV set that you remove the needle after insertion and leave the catheter in place. Works great and there are different gauges depending on your needs. BD Intima is the brand and name.

    Elizabeth Gartin RN BSN OCN
    RN Administrative Coordinator
    UVA Community Oncology

  • 6.  RE: Butterfly IV administration

    Posted 05-19-2019 18:37
    Peripheral Butterfly catheters such as the newer "closed system" are safe as long as the needle is successfully retracted and a plastic flexible catheter takes its place immediately during insertion.  But the actual butterfly plastic wings in themselves are safe.  Although, I personally have a higher success rate starting IVs with the traditional catheter/needles that are "open" for a second when you retract the needle to add on the extension set.  However, I know of some nurses that became better at their IV success rates post implementation of the Closed Butterfly peripheral sets.

    Ali Jackson RN BSN OCN