Butterfly needles, which are also known as winged infusion sets, are a very common needle style used to collect blood during a venipuncture. The butterfly needle consists of the stainless steel collection needle fitted with flexible “wings,” which the phlebotomist uses to grip the needle, and a valve that attaches to a tube, through which blood drawn flows into a collection tube. Butterfly needles are popular because of their ease-of-use, and their size makes them an optimal choice for drawing blood from children or geriatric patients.
Here’s what you need to know about butterfly needles, including when to use them and why they’re used.
A butterfly needle is a device used to access a vein for drawing blood or giving medications.
Some medical professionals call a butterfly needle a “winged infusion set” or a “scalp vein set.” The set gets its name because there are plastic “wings” on either side of a hollow needle used to access the vein.
While some elements of the butterfly needle can vary, most have a needle in a winged sheath or plastic covering that’s pulled back to reveal the needle. The needle is attached to tubing that may have a luer lock. This is a type of connection that you can twist a syringe onto.
A butterfly needle is used to access a superficial vein and can be used for drawing blood as well as for an IV injection. These needles are much easier to use and are much less painful for patients. This is because of the winged tubing which allows for greater flexibility. If you need to draw blood from a patient with small veins or ones that are hard to see and feel, it’s best to use a butterfly needle.
These needles are generally reserved for phlebotomy from patients with veins that are more fragile or difficult to access using a straight needle. Some phlebotomists may use a butterfly needle when numerous tubes are collected, as it is easier to change tubes using this method. Similar to a straight needle, the tip of a butterfly needle has a beveled edge. At the base of the needle are two plastic wings.
While all butterfly needles are similarly designed, there are variations. Butterfly needles are measured in gauges and typically range in size from 18-gauge to 27-gauge. The higher the gauge, the smaller the needle.
The most commonly used gauge bores are 21G and 23G, while extremely small gauge bores like 25G and 27G are rarely used because they cause the blood sample to clot, making it invalid to use for testing.
A larger needle, such as a 21G, is best used for drawing blood as the needle is a little thicker and allows more blood to be collected quicker.
Here are the steps that demonstrate how to use butterfly needles:
1. Wash hands with soap and water. Allow hands to dry before putting on gloves and any other required personal protective equipment.
2. Remove butterfly needle from packaging. Straighten out tubing and attach the Luer adapter to a fresh tube holder.
3. Choose the correct blood collection tube(s) based on the types of blood tests ordered. Place the blood collection tube into the tube holder without breaking the vacuum seal.
4. Warm the patient’s elbow crease with the portable, single use-warming device to aid in locating a vein.
5. Tie the tourniquet on the patient’s arm above the elbow crease and locate (palpitate) a vein. Note the vein’s depth and direction.
6. Swab the patient’s elbow crease with an alcohol swab. Allow alcohol to dry completely.
7. Pick up butterfly needle by its wings. One side of the wings will be textured for grip. Pinch the wings between your thumb and first finger and remove needle cap.
8. With your free hand, anchor the chosen vein and position the needle so that it is running parallel to the direction of the vein.
9. Insert the needle quickly, matching the depth of the vein with your angle of insertion (should be between 15 degrees and 30 degrees). You will feel a pop as you puncture the skin and a second pop and you enter the vein.
10. Press the blood collection tube down into the tube holder and look for a flash of blood in the tubing attached to the needle. If you do not see this flash and blood does not flow into the tube, carefully try repositioning the needle.
11. Untie and remove the tourniquet once blood has begun flowing into the tube. If you have multiple tubes to fill, you can gently use surgical tape to secure the needle by the wings so that it doesn’t move around on the patient.
12. Complete the rest of the venipuncture procedure, remove needle and activate the safety device on the needle to retract it. Bandage patient’s arm and dispose of the needle carefully in a sharps container.
While straight needles are much easier to use, butterfly needles offer a variety of benefits, including:
A 2016 study found that using butterfly needles to draw blood reduced rates of blood breaking down by half compared to using a person’s IV catheter to draw a blood sample.
Another earlier study found the type of needle used was one of the strongest predictors that a blood sample would or wouldn’t get destroyed. The researchers found that using butterfly needles was less associated with causing blood breakdown when compared with IV catheters.
Using the butterfly needle may also have more advantages for those with bleeding disorders, such as hemophilia or von Willebrand disease.
Butterfly needles enable IV access using a small needle for IV infusions or blood draws. Ideally, using a butterfly needle reduces the likelihood a person will experience profuse bleeding after an IV stick or blood draw.
Butterfly needles used for IV medications or fluids involve leaving an actual needle in the vein. On the other hand, an IV catheter is a thin, flexible catheter with no needle on the end. Leaving a needle in could potentially injure a part of the vein or nearby areas if accidentally removed.
While the amount of time a butterfly needle can be used for medications or fluid administration may vary based on the manufacturer, some recommend an infusion of no more than five hours with a butterfly needle.
Sometimes, butterfly needles can be difficult to insert properly. The short needle may be easily pulled back from the vein, and you may require another stick.
To prevent unintended sticks, some butterfly needles have a “push-button” function that retracts the needle when the blood draw is complete. Sometimes it’s possible to push this button before intended.
A butterfly needle may make the blood test process easier if you have veins that are typically very tough to access or have a medical condition that may cause you to bleed more than is typical.
Butterfly needles are very helpful to draw blood or to give IV fluids for people who traditionally have veins that are hard to find, collapsible, or small. With the right practitioner, butterfly needles can make blood draws a generally easy and fairly painless process.
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