Retractable butterfly needles

Retractable butterfly needles DEFAULT

BD Vacutainer® UltraTouch push button blood collection set

BD Vacutainer UltraTouch Push Button Blood Collection Set
BD Vacutainer UltraTouch Push Button Blood Collection Set
BD Vacutainer UltraTouch Push Button Blood Collection Set

With propriety BD PentaPoint and BD RightGauge needle technology, the BD Vacutainer® UltraTouch push button blood collection set aims to improve the patient experience by enhancing comfort, enabling clinicians to better access difficult veins, and reducing overall procedure times.

Minimized patient discomfort

The BD PentaPoint bevel requires 32% less penetration force.1

Improved venipuncture

The BD RightGuage™ ultra-thin wall cannula technology incorporated into the BD Vacutainer® UltraTouch™ Push Button Blood Collection Set allows clinicians to gain the benefits of using a smaller gauge needle without creating sample quality issues (hemolysis) typically associated with smaller gauges.2

Reduced accidental needlesticks

The single-handed, in-vein safety activation instantly retracts the needle after use, reducing accidental needlesticks by up to 88%.3

Improved blood culture sample collection

The ultra thin Right Gauge cannula improves sample fill volume, reducing blood culture underfill rates by 24%.4

Catalog no.DescriptionQuantity (per box)Quantity (per case)e-catalog
36736521-G x .75-in needle with 12-in tubing and luer adapter50200
36736423-G x .75-in needle with 12-in tubing and luer adapter50200
36736325-G x .75-in needle with 12-in tubing and luer adapter50200
36868921-G x .75-in needle with 12-in tubbing with a pre attached holder20100
36868823 G x .75-in needle with 12-in tubing and pre-attached holder20100
36868725 G x .75-in needle with 12-in tubing and pre-attached holder20100

Top Gun Phlebotomy – Butterfly Use: The Good, the Bad, and the Ugly

Expires: February 17, 2023



Brad Karon, M.D., Ph.D.
Chair, Division of Clinical Core Laboratory Services
Professor of Laboratory Medicine and Pathology
Mayo Clinic, Rochester, Minnesota


Contact us: [email protected]


Transcript and References


Dr. Pritt: Hi, I’m Bobbi Pritt, Director of the Clinical Parasitology Lab and Vice Chair of Education in the Department of Laboratory Medicine and Pathology at Mayo Clinic. In this month’s “Hot Topic,” my colleague Dr. Brad Karon will discuss recent information on the advantages and disadvantages to using butterfly needles for blood collection. I hope you enjoy this month’s Hot Topic, and I want to personally thank you for allowing Mayo Clinic the opportunity to be a partner in your patient’s health care.

Dr. Karon: For those of you who have not attended our phlebotomy conference here in Rochester, the title of my Hot Topic video today, Phlebotomy Top Gun, may seem a little odd—but I hope I’ll be able to explain to you what is “phlebotomy top gun,” and what we try to do at our annual phlebotomy conference. Today’s Hot Topic video presentation will address the use of butterfly needles for blood collection.


I have no disclosures relevant to today’s presentation.

Which of the following are currently demonstrated to be true regarding butterfly usage?

Every year at the Mayo Clinic Laboratories phlebotomy conference, I present a talk that’s called “Phlebotomy Top Gun.” The format of “Phlebotomy Top Gun” is a case-based presentation. I solicit from you, the attendees, cases, issues, or questions that you like to hear about. I present these as case-based scenarios, and using an audience response voting mechanism, the attendees of the conference vote on the action or answer they feel is appropriate to the case. I then present the collective experience from our practice, and the evidence and data that I can find related to the topic. At the end of the case, the attendees vote again. For each case, I can see whether I’ve been able to change anyone’s mind on the question at issue by presenting the data and information relevant to the particular topic. This is an actual case from a “Phlebotomy Top Gun” presentation at last year’s phlebotomy conference in Rochester. In this case the question was: “Which of the following are currently demonstrated to be true regarding butterfly usage?

  • Answer A: Butterfly usage increases hemolysis rates.
  • Answer B: Butterfly needles cost more than vacutainer needles.
  • Answer C: Use of butterfly needles increases rates of percutaneous needle exposures.
  • Answer D: All of the above are true.

And at this point during the live conference, attendees using an audience response system would vote for the answer they thought was most appropriate or correct, and we get to see in real time the distribution of results from our audience.

Butterfly Usage

There have been a number of published studies examining the effect of use of a butterfly needle, especially a smaller gauge butterfly needle like a 23 or 25-gauge needle, on rates of hemolysis in blood samples. This slide demonstrates the results of one such study performed by Dr. Lippi and colleagues in 2006. In this study, adult volunteers had three separate blood draws using three different types of butterfly needles. Experienced phlebotomy staff did all the blood draws using a vacutainer adapter, so you might say optimal conditions for blood collection using a butterfly needle. 14 different chemical analytes were tested from the tubes collected using either 21-gauge, 23-gauge, or 25-gauge butterfly needles. On average, the results of the biochemical tests did not differ by collection devices. However, potassium and AST—the chemical analytes most sensitive to the effects of hemolysis (both increasing with more free hemoglobin present in the serum or plasma sample)—, showed much more variability in the 23 and 25-gauge device compared to the 21-gauge. In fact, variability in potassium results was two-fold greater when a 25-gauge butterfly was used to draw blood compared to a 21- gauge butterfly. This is one of many studies demonstrating that hemolysis—or the amount of free hemoglobin present in serum or plasma samples—is much more variable when small diameter butterfly needles are used for blood collection. These authors therefore recommended that 25-gauge butterfly needles be used only for newborns or patients with very small veins to avoid rejection of blood specimens for excess hemolysis.

New Butterfly Techniques

The study by Lippi and colleagues that I just highlighted is one of many studies that have historically been used to justify limited use of butterfly needles for blood collection, and very restricted use of smaller gauge 23 and 25-gauge butterfly needles. More recently, at least one manufacturer of butterfly needles has reconfigured their devices to address this issue. In the end, hemolysis induced by collection from small butterfly needles is due to the small diameter inside the needle that blood must travel thru to reach the syringe or vacutainer adapter. By manufacturing the device where the wall of the needle is smaller, one manufacturer has produced a device that has the outside diameter of a 25-gauge butterfly, while maintaining the bore size (or internal diameter) of a 23- gauge needle. Both data from this manufacturer and internal data collected at Mayo Clinic suggests that this device maintains the tube fill rates and levels of free hemoglobin (or hemolysis) that are typically observed for a 23-gauge butterfly device. This device also was reconfigured with additional beveling to decrease pain associated with venipuncture. In recognition of the fact that some advances in manufacturing have allowed the production of small-gauge butterfly needles that may not increase hemolysis rates, guidelines from the Clinical and Laboratory Standards Institute have now been changed to reflect that, “the use of some 25-gauge needles increases the risk of hemolysis and rejected specimens.” Previously, these guidelines suggested that use of any 25-gauge needle would increase the risk of hemolysis.

Butterfly Usage

Among the most commonly cited concerns about butterfly needle usage is that percutaneous needle exposures, and the risk of infectious disease transmission associated with accidental needle sticks in healthcare workers, could be increased with the use of butterfly devices. This study from Yale University examined needlestick exposures over a two-year period from 1993-94. Three-quarters of accidental exposures were due to the use of a hollow-bore device. Among these, luer lock syringes were most common, followed second by butterfly needles, and third, by vacutainer needles. Looking at the rate of percutaneous exposures, the rate of exposure was four times greater with a butterfly needle compared to vacutainer needle blood collection. This study is one of many that demonstrated that use of butterfly collection needles does in fact increase the risk of occupational exposure associated with percutaneous injuries.

One reason—and likely the primary reason—that butterfly needles did result in more percutaneous injuries was the mechanism of safety device activation. In the past, butterfly needles required a two-handed safety device activation, such as pulling down a sleeve or sheath to cover the needle after blood collection. This required removing the needle from the arm and activating the safety device prior to disposal of the needle. This study describes a performance improvement initiative to reduce percutaneous exposures at one hospital. Prior to the intervention, rates of percutaneous exposure were three-fold greater when butterfly needles were used to collect blood specimen compared to vacutainer collections. The intervention in this study was to implement a push-button retractable butterfly needle, eliminating the need for two-handed activation of the safely device, and allowing for safety device activation prior to withdrawal of the needle from the patient’s arm. Over time, the exposure rate associated with the newer butterfly device came down to lower than the rate originally observed for vacutainers. These authors concluded that use of the newer butterfly with one-hand push-button safety activation was as safe as use of a vacutainer needle for blood collection.

Not all sites want to use a push button retractable butterfly needle device, so this study demonstrates results of a similar quality improvement/safely project within a hospital where the intervention in this case was the implementation of a butterfly needle with a safety sheath, which did require a two-hand activation of the safety device. While implementation of a butterfly needle with a safety sheath did reduce percutaneous exposures, rates remained much higher than exposure rates associated with vacutainer needles, and staff continued to have exposures due to incorrect activation of the safety device, or staff simply choosing not to use the safety sheath or device. This study and others like it demonstrate that to make butterfly use safe (or at least as safe as vacutainer needle use) for staff collecting blood, butterfly needles with a push-button retractable safety device should be used, and staff should be trained to never withdraw needles from patients without activating the safety device first.

Because butterfly needles do cost substantially more than vacutainer needles, one question that labs often ponder is why so many nursing staff choose to use butterfly needles for blood collection. This qualitative study asked nursing staff and clinical assistants exactly that question. Interviews were conducted with 11 nurses and 14 clinical assistants trained for blood collection, and themes were described from the transcribed interviews. Four themes emerged: Nurses and clinical assistants liked the mechanical features of the butterfly.  They found it easier to manipulate a butterfly needle compared to a vacutainer. They felt that butterfly collection was appropriate for sicker patients, or patients with poorer veins. And they used butterfly needles when they perceived that patients had or might have poor veins. These results are probably not all that surprising to many people listening today who are responsible for overseeing blood collection, but they do lend some evidence to commonly perceived or accepted reasons why people choose to use butterfly needles.

Summary of Butterfly Usage

Because I can’t go over all of the data and evidence I would normally present in a case at the phlebotomy conference, and that I in fact presented last year, on this slide, I have attempted to summarize the material I presented during this case on butterfly usage last year. Many of the reasons that we have cited for avoiding butterfly blood collection in the past may no longer apply to butterfly needles due to improved design of some devices. In particular, use of a 25-gauge butterfly needle with a wider bore, and use of push-button safety device activation, have reduced concerns related to excess hemolysis and percutaneous exposure of health care workers. While I did not have time to cover this material today, we have noted within our practice here at Mayo Clinic that use of butterfly needles for blood collections can still lead to hemolyzed or clotted blood specimens. And this is particularly true when there are many blood tubes that need to be collected, or very large orders for blood collection. Thus use of smaller gauge butterflies is best limited to pediatric patients or patients with small veins. Institutions should do everything possible to encourage or limit usage of butterfly collection devices to only those with one-hand push-button activation safety device. Strategies that have been effective to limit butterfly usage include training staff first with a vacutainer device before they are allowed to try or get comfortable with a butterfly. Education of staff on cost and potential downsides of butterfly collection (particularly use of butterflies when multiple blood tubes must be collected), and the associated risks—at least in our experience—creates risk of hemolysis and clotting when collecting multiple tubes with a butterfly. And if all else fails, simply limiting access of butterfly devices to pediatric areas or areas where their use is likely to be required.

Which of the following are currently demonstrated to be true regarding butterfly usage…

At this point during the phlebotomy conference, I would then return to the original question that I polled the audience on. The attendees of the conference would use the audience response system to vote again, and I would share with the audience what I believe is the correct or intended response to the case or question. Based upon the available data and our collective experience here at Mayo, my opinion is the single best answer to this question would be option B. It will always be true that butterfly needles cost more than vacutainer needles, or at least until someone makes a much cheaper or less expensive butterfly. While we have identified specific situations (such as large blood collections or the need to collect multiple tubes) where butterfly needles in our experience may increase the risk of hemolyzed or clotted samples, more recent evidence suggests that this is not universally true, or true in all situations. Use of butterfly devices with one-hand push-button safety device activation does not appear to increase the risk of percutaneous exposure for health care workers compared to use of vacutainer needles. So again, in my opinion, the answer to this case is option B

Thank You

Thank you for your time and attendance today. If you liked today’s presentation, or even if you didn’t, please do consider attending our next Phlebotomy conference on April 23rd and 24th, 2020, here in Rochester, MN. Learning takes place via both large-group didactic sessions, and small breakout sessions that allow more interaction with conference speakers. Tours of Mayo Clinic facilities are also offered during the conference. Thank you for listening today, and have a wonderful day.

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All About Butterfly Needles

A butterfly needle is a device used to draw blood from a vein or deliver intravenous (IV) therapy to a vein. Also called a winged infusion set or scalp vein set, a butterfly needle consists of a very thin hypodermic needle, two flexible "wings," a flexible transparent tubing, and a connector. The connector can be attached to a vacuum tube or collection bag to draw blood or to tubing from an infusion pump or IV bag to deliver fluids or medications. Medications can also be delivered directly to the connector via a syringe.

Butterfly needles offer certain advantages over straight needles. For instance, they allow for more precise placement, particularly in hard-to-access veins. They aren't the best option in every case, however.

Mistaken Identity

At first glance, a butterfly needle resembles a Huber needle, which is also winged. Huber needles, however, are bent at a 90-degree angle so that they can be securely placed in an implanted chemotherapy port.

What Butterfly Needles Are Used For

Phlebotomists regularly use butterfly needles to obtain blood samples for complete blood counts (CBC), cholesterol tests, diabetes monitoring, STD screens, and other blood-based tests. These needles are also commonly used at blood banks for people wanting to donate blood.

Butterfly needles can also be used to deliver intravenous fluids if you are dehydrated and either cannot drink fluids or cannot drink enough to compensate for fluid loss. They are also useful for delivering medications (such as pain medications) straight into a vein or gradually infusing IV therapies (such as chemotherapy or antibiotics) intravenously.

Though butterfly needles can be left in a vein for five to seven days if properly secured, they are more commonly used for short-term infusions.

Regular or ongoing infusions typically accessed through a larger vein via a central line or peripherally inserted central catheter (PICC) line.


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.

By way of illustration, a 27-gauge needle is the size commonly used for insulin injections. Smaller gauge needles are used if an injectable fluid is thick or if blood is being collected for transfusion. Most butterfly needles are no more than three-quarters of an inch (19 millimeters).

The IV equipment or collection container is attached to tubing that's connected to the needle, rather than the needle. This is helpful, as there is less chance of injury if either is yanked or dropped.

Tubing can range in size from 8 inches to 15 inches (20 to 35 centimeters). Shorter tubes are used for blood draws. Longer ones are intended for IV applications and may have roller valves to regulate the flow. The tubes may also be colored so that nurses can differentiate which line is which if more than one is used.

Some butterfly needle connectors have built-in "male" ports that can be inserted into vacuum tubes. Other connectors have "female" ports into which syringes or lines can be inserted.

How Butterfly Needles Are Used

During venipuncture (the insertion of a needle into a vein), a phlebotomist or nurse will hold the butterfly needle by its wings between the thumb and index finger. Because the hypodermic needle is short and the grasp is close to the needle, the butterfly needle can be placed more accurately than a straight needle, which can often roll or wiggle in the fingers.

The short, thin needle is inserted toward a vein at a shallow angle. Once inserted, the venous pressure will force a small amount of blood into the transparent tubing, providing confirmation that the needle is correctly placed. The wings can also serve to stabilize the needle once it is in place, preventing it from rolling or shifting.

Once used (blood is drawn or medication is delivered), the entire unit is thrown away in a sharps disposal container. The puncture wound is then bandaged.

What to Do if You Have a Sharps Injury


Because of their small size (far smaller than an intravenous catheter) and shallow-angle design, butterfly needles can access superficial veins near the surface of the skin. This not only makes them less painful to use, but allows them to access veins that are small or narrow, such as those in infants or the elderly.

Butterfly needles are ideal for people with small or spastic (rolling) veins and can even be inserted into the tiny veins of the hand, foot, heel, or scalp.

Butterfly needles are ideal for people who are hesitant about needles because they are less threatening.

They are also less likely to cause profuse bleeding, nerve injury, or a vein collapse once the needle is removed.

Newer models have a slide-and-lock sheath that automatically slides over the needle as it is extracted from a vein, preventing needlestick injuries and the reuse of a used needle.

If you have been told that you have small veins and have had challenging blood draws in the past, you might consider requesting the use of a butterfly needle.


With that being said, butterfly needles are not for everyone.

Because of their small needle size, blood collection tends to be slower. This can be problematic at a blood bank if a person is squeamish or in urgent situations where blood is needed fast. In situations like these, the selection of the needle size is key.

Even for a routine blood draw, the wrong needle size can result in blockage and the need for a second draw if a large quantity of blood is needed.

Because a needle is left in the arm rather than a catheter or PICC line for the purpose of an infusion, a butterfly needle can damage a vein if the unit is suddenly yanked. Even if the right size needle is used, the needle can become blocked during treatment if not correctly placed.

As a rule of thumb, butterfly needles should only be used for IV infusions of five hours or less.

Tips for Easier Blood Draws

Thanks for your feedback!

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Venipuncture Technique. In: Sedation. 6th edition. 2018:308-318. doi:10.1016/b978-0-323-40053-4.00024-x

  2. Ohnishi H, Watanabe M, Watanabe T. Butterfly needles reduce the incidence of nerve injury during phlebotomy. Arch Pathol Lab Med. 2012;136(4):352. doi:10.5858/arpa.2011-0431-LE

Additional Reading
  • Ialongo, C. and Bernardini, S. Phlebotomy, a bridge between laboratory and patient.Biochem Med (Zagreb). 2016 Feb 15;26(1):17-33. DOI: 10.11613/BM.2016.002.

  • Wolowitz, A.; Bijur, P.; Esses, D. et al. Use of Butterfly Needles to Draw Blood Is Independently Associated With Marked Reduction in Hemolysis Compared to Intravenous Catheter. Society for Academic Emergency Medicine Annual Meeting; Atlanta, Georgia; May 2013. DOI: 10.1111/acem.12245.

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