Infusing Factor with Butterfly Needle

These instructions are for caregivers of Children's Hospital of Philadelphia (CHOP) patients who are prescribed factor for hemophilia management.

Important information:

After learning how to store, manage and mix your child's factor, you are now ready to learn how to find a vein and infuse factor. Your homecare nurse will support you at each visit as you learn the infusion steps to care for your child with hemophilia

Patient instructions:

Remember! Mix factor only after a vein is located. Factor should be used immediately. It is best to infuse it within 3 hours after mixing it. If you need to delay infusion longer than an hour speak with your hemophilia treatment team for next steps.

Preparing to infuse factor with a butterfly needle

Gather supplies:

• Factor dose prepped in syringe after identifying vein

• Alcohol swabs

• Exam gloves

• Cleaning solution for preparing work area

• Tourniquet

• Puncture proof sharps container

• Gauze pads

• IV Butterfly needle

• Topical lidocaine numbing cream if ordered

• Adhesive bandage

Locating veins

• 
  Figure 1 (left) and Figure 2 (right)

  It is important to find a good, straight vein to infuse the factor. Look for veins on the hands or the inside of the elbow (see Figure 1).

• Place a tourniquet 2-3 inches above the vein to help the vein stand out. Make sure the tourniquet is tight enough to restrict some blood flow while maintaining a pulse below the tourniquet.

• Using your fingertip, to feel that the vein is spongy (see Figure 2).

Encourage your child to drink 1 to 2 cups of fluid before starting; this will help the veins stand out. Cold, dehydration or illness can make it difficult to locate veins for infusion. Use warm towels, or place hands under warm water to help expand the veins.

1. Perform hand hygiene.

2. Locate and choose a vein. If numbing cream was ordered for your child, apply it over the vein as directed. Wipe off cream completely before inserting the butterfly needle.

3. Once a vein has been chosen, remove the tourniquet and prepare the factor as directed.

4. 
   Make sure the tourniquet is not too tight by feeling for a pulse below the tourniquet.

   Place the tourniquet on snuggly above the vein insertion site that you have chosen. Always place the tourniquet above the infusion site as noted on the picture below. The tourniquet will make your child's veins expand.

Inserting the needle

1. Put on exam gloves.

2. Clean the vein site using an alcohol pad in a circular motion starting inside and moving out for 15 seconds. Allow to dry for 15 seconds.

3. Pick up butterfly needle that is filled with factor and attached to syringe. When ready to insert the needle, remove the cap. Do not let the needle touch any surface before inserting in vein, it must remain sterile.

4. 
   Figure 4 (left) and Figure 5 (right)

   A needle has a point and a wider opening above the point, this is called the bevel. (See Figure 4). Make sure the needle slides into the vein with the bevel up. Hold the needle at a slight angle to the skin. Remember to insert needle into the vein towards the heart, which is the blood flow direction. (See Figure 5)

5. Once the needle is in the vein, look for blood flow through the butterfly tubing. If you don't see blood flow, reposition the needle without removing it from the vein. If the site is puffy or there is no blood return, the needle is not in the vein.

   • Remove the needle and place a gauze pad over site with pressure for up to five minutes. Position safety guard over the needle and dispose of it in an appropriate container. Do not recap needle!

   • Contact your hemophilia treatment team if you do not succeed in 2-3 sticks

6. When needle is in the vein, with good blood return, remove the tourniquet and push the factor slowly into the vein with syringe plunger. Keep the needle secure with the hand that is holding the butterfly. Follow your factor product directions for a number of minutes for infusion.

   • Make sure you check for blood return by slowly pulling back on plunger during the infusion. If there is swelling or bulging of the area and no blood return when pulling back on the plunger, the needle may have moved and is no longer in the vein.

   • Stop infusing, remove needle and place a gauze pad over site with pressure for up to five minutes. Position safety guard over the needle and dispose of it in an appropriate container. Do not recap needle.

7. When the infusion is finished, remove the needle and place a gauze pad over site with pressure for up to five minutes. Position safety guard over the needle and dispose in sharps container. Do not recap the needle.

8. When you have finished applying pressure, place an adhesive bandage over site.

9. Remove your exam gloves and wash your hands.

10. Record the dose in your logbook.

Please contact your CHOP hematology team with questions or concerns:

Division of Hematology

215-590-3535

Hemostasis and Thrombosis Center

For non-urgent issues, send your team a message in the MyCHOP portal.

Reviewed on August 1, 2023, by Kelly Monacella, RN, MSN