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Butterfly Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Butterfly and links to relevant pages within the course.

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Phlebotomy
Discussion

A phlebotomist should never use an arm with restricted usage for the venipuncture. Even if no sign is posted, the patient may tell you not to use a particular arm for various reasons, i.e. previous mastectomy, history of phlebitis, active AV fistula, etc. Do not draw blood above an IV line. If blood is taken from a vein above an IV line it might be diluted by the IV fluid, which could cause incorrect test results. In this case, Bobby should choose a vein on the dorsum of Mrs. Grayson's hand, below the IV. A butterfly needle would facilitate drawing blood from these small hand veins.Relevant topics:Alternate sites, Sites to avoid, Signs, Arms to avoid

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Case

Julie Smith, a newly certified phlebotomist at Northlake Hospital, entered a patient's room on the third floor for a routine blood draw. The patient was an elderly woman who had very small fragile veins. Julie therefore decided to use a safety butterfly needle attached to a Vacutainer tube in order to draw the blood. When Julie was finished with the venipuncture, she detached the butterfly needle from the Vacutainer, and approached the Biohazard needle disposal box. She noticed that the disposal box was full , but decided to try to fit the butterfly into the box anyway. Holding the butterfly by the tubing, she tried to push the butterfly into the box. The needle suddenly recoiled and stuck Julie's finger. Julie left the patient's room in a panic and headed back to the lab to report the needle stick injury.

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What should Julie have done to prevent the needle stick?View Page
Discussion

All biohazard needle disposal containers are marked with a "full" line at about ¾ of the box's volume. Therefore, needles should never be sticking out of the top of the container. Julie should never have attempted to put the needle into an overly full container. The needlestick safety and prevention act requires the use of butterflies with built in safety devices. However, they are only effective if properly activated. When disposing of a butterfly needle, hold its "wings" with one hand, and the hub at the opposite end of the tubing with your other hand to prevent the needle from recoiling. Butterflies should be used with extra caution since they are the number one cause of needle stick injuries.Relevant topics:Needle disposal, Sharps disposal containers, Butterfly needles with safety 1, Butterfly needles with safety 2, Needle-stick injuries, Built-in safety features, Angel Wing™ safety butterfly, Punctur-Guard™ safety butterfly

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Butterfly needles with built-in safety features continued

Two examples of butterfly needles with built-in safety devices are shown.The Punctur-Guard™ (Bioplexus), shown above, uses an internal blunt needle which is activated after blood is drawn. The activated device showing the blunt internal needle is shown in the inset on the upper right. The Angel Wing ™ (Monoject), is activated by sliding a safety shield over the needle after venipuncture.

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Butterfly needles

Butterfly needles, also known as a winged infusion set, are often used for difficult venipunctures including pediatric venipunctures.

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Butterfly needles continued

Butterfly needles may be used with a syringe or a holder and vacuum collection tube system. They are usually 21, 23, or 25 gauge.

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Butterflies with built-in safety features

You will be using butterfly needles with built in safety features. Butterfly needles are the number-one cause of needlestick injuries, so proper use of their safety devices is critical. Their use is described in greater detail in the section on butterfly needle blood collection.

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Butterfly needle - Butterfly needle collections

Butterfly needles (also known as a winged infusion set), are available in smaller gauges, and are used to draw venous blood from children, and adults with difficult veins.

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Butterfly needle - Angel WingTM safety butterfly

The Angel Wing™ (Monoject), is activated by sliding a stainless steel safety shield over the needle after withdrawal from the vein.The Angel Wing™ (Monoject), is activated by sliding a stainless steel safety shield over the needle after withdrawal from the vein.

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Butterfly needle - Butterfly needles with built-in safety features

You will be using butterfly needles with built-in safety device. The safety device must be activated upon completion of the blood collection.You will be using butterfly needles with built-in safety device. The safety device must be activated upon completion of the blood collection.The Angel Wing™ (Monoject) safety butterfly is shown here.

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Syringe - Syringe blood collections continued

Syringes may be used in two ways:Syringes may be used in two ways:A syringe may be attached to a butterfly or winged infusion set.

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Heelstick - Pediatric collection procedures: Introduction

Veins of small children and infants are too small for venipuncture;Safety Lancets are used to puncture the skin and collect capillary blood.Butterfly needles may be used to collect venous blood in older children.

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Butterfly needle - Butterfly needle collections continued

Butterfly needles come attached to a small tube which may be connected to:An evacuated tube holder, orA syringe.

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Butterfly needle - Butterfly needles and needle-stick injuries

Butterfly needles, because of their flexibility, are the number one cause of needle-stick injuries among phlebotomists.Use extra caution when using butterfly needles.

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Butterfly needle - Punctur-GuardTM safety butterfly

Another type of safety butterfly needle is shown to the right.The Punctur-Guard™ (Bioplexus) uses an internal blunt needle (arrow) that is activated by manually locking a small lever on the butterfly. Please refer to your facility's and the manufacturer's procedure manuals for detailed instructions.

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Collection methods

Blood for culture can be collected in several ways:Standard needle attached to a syringe.Butterfly needle attached to a syringe.Blood culture bottle attached directly to tube holder (not generally recommended).Follow you own facilities' procedure for blood culture collection.

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Routine Venipuncture
Correct Fill

Fill blood collection tubes completely (until vacuum is exhausted) to ensure the correct blood to anticoagulant ratio necessary for accurate patient results. Specimens may be rejected by the laboratory if the tube is short-filled or over-filled. To avoid short-filling of tubes, the phlebotomist must ensure that the blood flow stops completely before removing the tube from the needle. When using a winged device (butterfly) to collect blood for coagulation studies (e.g., protime, aPTT), the phlebotomist must draw a light blue top "waste" tube before attaching another light blue top tube for testing. If the air in the tubing of the winged device is not displaced into a waste tube and is drawn into the tube used for testing, the tube used for testing will short-fill. The laboratory may reject the specimen because of invalid blood to anticoagulant ratio.

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Bobby Jones, a phlebotomist at Community Hospital, enters the room of Mrs. Mary Grayson with a physician's order for blood tests. After greeting Mrs. Grayson, identifying himself, and properly identifying the patient, using two methods of identification, Bobby prepares for the venipuncture.As he approaches the patient's bed, he notices a sign posted above the bed that reads: "Restricted left arm use. Do not use left arm for venipuncture." Bobby prepares to use the patient's right arm and notices an intravenous (IV) line in Mrs. Grayson's right arm positioned in a vein slightly above her wrist on the dorsum (top) of her forearm.Which site should Bobby choose for the venipuncture?View Page

Special Topics in Phlebotomy
Procedure for Using a Winged Blood Collection Device to Collect a Specimen for Coagulation Tests

A light-blue top tube (a blood collection tube containing 3.2% sodium citrate) that will be used for coagulation testing must be filled to completion. Under-filling the tube changes the ratio of blood to anticoagulant. This can affect the accuracy of coagulation tests that are performed using this specimen. If a winged blood collection device (butterfly) is used to collect a light-blue top tube for coagulation studies, a waste tube should be drawn first, if the coagulation tube is the first tube to be collected for patient testing. The waste tube must also be a light-blue top tube or a tube that contains no additives. This waste tube is drawn first to remove the air in the tubing of the winged collection device. Once blood flows through the tubing, the waste tube can be removed and discarded. The waste tube does not need to be completely filled. If the air is not displaced from the tubing into a waste tube, it will be drawn into the tube used for testing and cause a short-fill of the tube. Less volume of blood in the tube alters the required blood to anticoagulant ratio needed for coagulation studies.

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