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
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.
|What should Julie have done to prevent the needle stick?||View Page|
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
|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.
Butterfly needles, also known as a winged infusion set, are often used for difficult venipunctures including pediatric venipunctures.
|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.
|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.
|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.
|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.
|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.
|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.
|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.
|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.
|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.
|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.
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.