Using a push button butterfly needle involves a series of precise steps, from preparation and venipuncture to blood collection and safe needle retraction, ensuring both effective sample acquisition and enhanced safety for healthcare professionals.
A push button butterfly needle, also known as a winged infusion set with an integrated safety mechanism, is a specialized medical device primarily used for drawing blood, administering intravenous fluids, or delivering medications. Its key feature is a button that, when pressed, instantly retracts the needle into a protective sheath, significantly reducing the risk of accidental needlestick injuries after use.
Understanding the Components
Before diving into the steps, it's helpful to know the main parts of a push button butterfly needle:
- Needle: A small-gauge, short needle designed for precise venipuncture.
- Wings: Flexible, textured tabs on either side of the needle hub, used to grip and stabilize the device during insertion.
- Tubing: A clear, flexible tube that extends from the needle hub to the adapter.
- Luer Adapter/Multi-Sample Adapter: The connector at the end of the tubing, designed to attach to evacuated blood collection tubes, syringes, or IV lines.
- Push Button: The safety mechanism, typically located on the needle hub, which when pressed, retracts the needle.
Step-by-Step Guide to Using a Push Button Butterfly Needle
Proper technique and adherence to safety protocols are crucial for a successful and safe procedure.
1. Preparation and Patient Assessment
Thorough preparation ensures efficiency, patient comfort, and safety.
- Gather Supplies: Collect all necessary equipment before approaching the patient:
- Push button butterfly needle (select appropriate gauge)
- Evacuated blood collection tubes (verify type and expiration dates)
- Tourniquet
- Antiseptic wipes (e.g., chlorhexidine, iodine, or alcohol pads)
- Sterile gauze pads
- Medical tape or cohesive bandage
- Gloves (non-latex if patient allergy)
- Sharps disposal container (puncture-resistant and easily accessible)
- Labeling supplies
- Hand Hygiene: Perform thorough handwashing or use an alcohol-based hand rub.
- Don Gloves: Put on clean, well-fitting medical gloves.
- Patient Identification: Verify the patient's identity using at least two identifiers (e.g., name and date of birth).
- Patient Education & Consent: Explain the procedure clearly, answer any questions, and obtain verbal consent.
- Positioning: Position the patient comfortably, with the chosen arm extended and well-supported.
2. Site Selection and Preparation
Choosing and preparing the venipuncture site correctly minimizes discomfort and increases success.
- Apply Tourniquet: Place the tourniquet 3-4 inches (7.5-10 cm) above the intended venipuncture site. Do not leave it on for more than one minute to prevent hemoconcentration.
- Palpate Vein: Locate a suitable vein. Ideal veins are visible, palpable, elastic, and well-supported. Avoid areas with rashes, scarring, or hematomas.
- Cleanse Site: Using an antiseptic wipe, cleanse the venipuncture site vigorously in concentric circles, moving outward from the center. Allow the antiseptic to air dry completely (typically 30-60 seconds) to ensure effectiveness and prevent stinging upon needle insertion. Do not re-palpate the cleansed area.
3. Venipuncture
This is the process of inserting the needle into the vein.
- Prepare Butterfly Needle: Remove the needle cap, ensuring the bevel (angled opening) of the needle is facing upward.
- Anchor Vein: Use your non-dominant thumb to gently pull the skin taut below the venipuncture site to anchor the vein and prevent it from rolling.
- Insert Needle: Hold the butterfly's wings between your thumb and forefinger. Insert the needle smoothly and swiftly, bevel up, into the chosen vein at a shallow angle (typically 10-15 degrees). A slight "pop" may be felt as the needle enters the vein.
- Confirm Placement: Observe for a "flashback" of blood into the tubing, indicating successful venipuncture.
4. Blood Collection
Once the needle is correctly placed, blood can be collected into the appropriate tubes.
- Stabilize: Gently secure the butterfly wings against the patient's arm with your non-dominant hand to prevent movement.
- Attach Tubes: Using your dominant hand, attach the first evacuated blood collection tube to the Luer adapter on the end of the butterfly tubing.
- Crucial Information: Each evacuated tube contains a precise vacuum. When the needle at the end of the butterfly's tubing pierces the rubber stopper of the blood collection tube, this vacuum actively pulls blood from the patient, through the butterfly needle and tubing, directly into the tube.
- Fill Tubes: Allow the tube to fill until the vacuum is exhausted. Ensure tubes are filled in the correct "order of draw" to prevent contamination of specimens with additives from other tubes.
- Remove Tubes: Once a tube is full, gently remove it from the adapter and attach the next tube as needed. Invert tubes containing additives immediately after removal to ensure proper mixing.
- Release Tourniquet: Once the last tube is filling or just before withdrawing the needle, release the tourniquet. This prevents hemoconcentration and reduces discomfort.
Here's a common order of draw for multiple tubes:
| Order of Draw (Common) | Tube Type / Color | Additive Example | Common Laboratory Test Examples |
|---|---|---|---|
| 1. | Blood Culture | SPS | Sepsis detection, organism identification |
| 2. | Light Blue | Sodium Citrate | Coagulation studies (PT, PTT, INR) |
| 3. | Red / Gold (SST) | Clot Activator / Gel | Serology, chemistry, thyroid function, hormones |
| 4. | Green | Heparin | Stat chemistry, ammonia, electrolytes |
| 5. | Lavender / Pink | EDTA | Complete Blood Count (CBC), A1C, blood typing |
| 6. | Gray | Sodium Fluoride | Glucose (fasting), lactic acid, alcohol levels |
5. Needle Retraction and Disposal
This final step highlights the safety feature of the push button butterfly needle.
- Withdraw Needle: Place a fresh gauze pad over the insertion site without applying pressure to the needle itself. Smoothly and swiftly withdraw the butterfly needle from the vein.
- Activate Safety Mechanism: Immediately after withdrawing the needle from the patient's arm, press the designated push button on the butterfly device. The needle will instantly and automatically retract into the plastic housing, making it impossible for accidental sticks.
- Sharps Disposal: Without delay, drop the entire retracted butterfly needle device into an approved, puncture-resistant sharps disposal container. Never attempt to recap a used needle.
- Learn more about sharps safety from the CDC Sharps Safety.
- Apply Pressure: Once the device is safely disposed of, apply firm pressure to the venipuncture site with the gauze pad until bleeding stops (typically 2-3 minutes).
- Bandage: Apply a clean bandage or medical tape over the gauze.
- Label Tubes: Label all collected tubes immediately at the patient's bedside, including patient name, date of birth, date, time, and your initials.
Best Practices and Key Safety Considerations
- Patient Comfort: Always prioritize clear communication and gentle technique.
- Needle Gauge: Use the smallest gauge needle appropriate for the patient's vein size and the required blood volume.
- Inversion of Tubes: Gently invert tubes with additives 5-10 times immediately after collection to ensure proper mixing; vigorous shaking can cause hemolysis.
- Sharps Safety: The primary benefit of the push button mechanism is injury prevention. Always activate it and dispose of the device immediately.
- Documentation: Document the procedure, including the venipuncture site, number of attempts, and any patient reactions.
- For comprehensive guidelines on phlebotomy, refer to resources like the World Health Organization's Guidelines on Drawing Blood.
- Order of Draw: Strict adherence to the order of draw is essential for accurate lab results. You can find more details on sites like Quest Diagnostics - Order of Draw.
By following these detailed steps and adhering to best practices, healthcare professionals can effectively and safely use a push button butterfly needle for blood collection, ensuring both patient care and the safety of the user.
