The butterfly needle, formally known as a winged infusion set, is a specialized device designed for accessing smaller or more fragile veins. Its unique design includes two flexible, plastic wings attached to a short, small-gauge needle, allowing for greater stability and precision during insertion. These needles are frequently employed in pediatric care, geriatrics, or for patients whose vein structure challenges standard straight catheters. The needle connects to flexible tubing that terminates in a Luer connector, the standardized attachment point for the IV line or syringe. This design minimizes movement at the insertion site and is typically used for short-duration intravenous therapy or single blood draws.
Essential Preparation Steps
Preparation ensures patient safety and procedural success. All necessary equipment must be gathered and organized, including:
- The correct gauge butterfly needle
- Antiseptic wipes and sterile gloves
- The IV solution and administration tubing
- Tape or transparent dressing
- A tourniquet
Confirming the patient’s identity and verifying the prescribed medication or fluid prevents administration errors.
The venipuncture site selection usually involves veins in the forearm or the back of the hand due to their accessibility and relative stability. The butterfly’s small gauge is ideal for these smaller peripheral veins. Apply the tourniquet four to six inches above the insertion site, tightening it enough to impede venous flow but not restrict the arterial pulse. This pressure distends and engorges the vein, making it more visible and easier to access.
The Venipuncture and Insertion Process
Once the vein is adequately distended by the tourniquet, the insertion site must be thoroughly cleaned with an appropriate antiseptic solution, following the manufacturer’s directions for contact time. Allow the antiseptic to fully air-dry on the skin, as this prevents a stinging sensation and ensures microbial reduction. Use the non-dominant hand to stabilize the chosen vein by applying gentle traction to the skin just below the puncture site.
This stabilization prevents the vein from rolling away during the needle insertion. Hold the butterfly needle by its flexible wings, ensuring the bevel faces upward toward the ceiling. This upward orientation ensures the sharpest part of the needle enters the skin first, minimizing tissue trauma. Insert the needle through the skin and into the vein lumen at a shallow angle, typically between 10 and 15 degrees relative to the skin surface.
A steeper angle risks puncturing the posterior wall of the vein, which can cause fluid leakage and bruising. A slight decrease in resistance is often felt as the needle tip enters the vein lumen. Confirmation relies on observing the “flashback” of blood into the transparent tubing attached to the needle, indicating the needle tip is correctly positioned inside the vessel.
Once flashback is confirmed, advance the needle slightly further (about one-eighth of an inch) to ensure the entire bevel is fully seated within the vessel. Immediately release the tourniquet to restore normal blood flow and prevent patient discomfort or hematoma formation. This release should be smooth and quick before any further manipulation of the needle.
Securing the Device and Starting the Infusion
After successful venipuncture and tourniquet removal, secure the needle apparatus to maintain its position. Press the flexible wings flat against the skin and secure them with sterile tape placed over the wings and the hub. A second piece of tape is often applied to create a small loop with the tubing, acting as a strain-relief mechanism to prevent accidental dislodgement.
Connect the IV administration tubing to the butterfly’s Luer lock terminal, twisting until a secure, closed system is established. If required, inject a small amount of sterile saline to flush the line and confirm patency before connecting the main infusion bag. Open the clamp on the IV administration set to allow the fluid to begin flowing into the vein.
The flow rate must be regulated to match the prescribed medical orders, whether controlled manually by a roller clamp or managed by an electronic infusion pump. Initial monitoring is necessary to identify immediate complications. Check the insertion area for signs of infiltration (swelling and coolness caused by fluid leaking outside the vein) or hematoma formation (blood accumulation beneath the skin).
Discontinuing the IV and Safe Disposal
When the infusion is complete, discontinuation must be executed safely and efficiently. First, stop the flow of intravenous fluid by closing the roller clamp or pausing the electronic infusion pump. Carefully remove the securing tape and any dressing material around the butterfly wings, taking care not to pull on the needle itself.
Hold a clean gauze pad ready as the needle is withdrawn swiftly and smoothly from the vein, paralleling the angle of original insertion. Apply immediate, firm pressure to the puncture site to encourage hemostasis and prevent bleeding or bruising. Maintain pressure for at least one to two minutes, or longer if the patient is on anticoagulant therapy. After withdrawal, activate the safety mechanism on the butterfly needle to shield the exposed sharp tip. Dispose of the entire winged infusion set immediately into a designated, puncture-proof sharps container.