Extraction Techniques and Applications: Biological/Medical and Environmental/Forensics

K. Lew , in Comprehensive Sampling and Sample Preparation, 2012

3.05.5.2.2 Butterfly Needles

Also known as winged infusion sets, these needles are used for both intravenous delivery of fluids or drugs or for blood collection ( Figure 8). 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. There is a flexible tube several inches long leading to another needle with a retractable sheath. This portion of the collection set can be attached to a tube holder where the blood sample is collected. An advantage of a butterfly needle is that the phlebotomist has a visual indicator of whether the needle is successfully in the patient's vein (Figure 9). A small amount of blood will enter the first portion of the tubing (a few millimeters in) if the needle is in the vein. Blood will flow through the tubing and into the collection tube once an evacuated tube is inserted into the opposite end of the needle attached to the tube holder.

Figure 8. Butterfly needle or winged infusion/collection set. A needle with plastic wings is located on one end. It is joined by a narrow tube to the other end which contains a hub to connect to the tube holder.

Figure 9. Butterfly needle successfully in a patient's vein. The circled area shows that there is a small amount of blood that has entered the tubing. This indicates that the needle is in the correct location in the vein and an evacuated tube can be attached to the other end of the collection set to obtain a blood specimen.

Some butterfly needles contain a switch to allow the needle to safely retract from the vein and into a protective shield, thus minimizing exposure to sharps. Others may require manual retraction or covering of a safety shield once the needle is removed from the patient.

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Venipuncture Technique

In Sedation (Sixth Edition), 2018

Hollow Metal Needle

Although not recommended for use in routine IV drug administration, the hollow metal needle may be used for venipuncture in emergency situations or in procedures, such as the drawing of blood samples for laboratory analysis, when only short-term cannulation is required. The hollow metal needle will almost always be attached to a syringe, which contains a drug to be injected or into which blood is to be drawn.

Basic Technique—Hollow Metal Needle

The basic technique of venipuncture is the same as that described earlier for the winged infusion set. However, once the metal needle enters the vein, great care must be taken as the needle is advanced, because it is often difficult to obtain the correct needle angulation within the vein with a syringe attached (syringes are available that have an eccentrically placed needle, making venipuncture somewhat easier). The tourniquet is removed and the syringe held securely in place.

Before the administration of the drug, an aspiration test must be performed to confirm that the needle tip remains within the vessel's lumen. With one hand holding the syringe in position, the other hand gently pulls the plunger of the syringe until a backflow of blood is observed. This technique (drawing of blood into the syringe) is called barbotage (Fig. 24.13). The drug is then administered.

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Electron Microscopy of Model Systems

Wiebke Möbius , ... Frédérique Varoqueaux , in Methods in Cell Biology, 2010

2 Perfusion Fixation

a Required Items

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Anesthetics: Avertin

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Styrofoam board

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Peristaltic pump, tubing, and adaptor

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Hypodermic injection syringe and needles

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27-gauge winged infusion set

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Dissection tools (scissors, forceps, clamps, needles)

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Flushing solution: PBS or HBSS.

b Anesthetics: Avertin

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Take 2   g Avertin

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Add 2   ml tertiary amylalcohol

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Warm up 96.5   ml H2O to maximum 40°C prior to adding it to the Avertin/amylalcohol solution

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Stir for 30   min

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Filter through a 0.2   µm filter

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Make 5   ml aliquots in dark tubes and store at −20°C; Avertin is sensitive to light!

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After thawing the solution is ready to use. Store in the dark at 4°C for maximum 4 weeks.

c Perfusion

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Prepare the perfusion tubing: it should be filled with the flushing solution without air bubbles.

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Deeply anesthetize the mouse by injecting intraperitoneally 0.2   ml Avertin per 10   g body weight. The anesthesia usually lasts approximately 1   h. Check anesthesia by pinching a paw. The mouse should not twitch.

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Stretch out the mouse on a Styrofoam board with needles (Suppl. Fig. 1A).

Suppl. Fig. 1. Perfusion fixation of a mouse: (A) The anesthetized mouse is fixed with needles on a Styrofoam board. The peristaltic pump is ready to use, tubing is filled with warm flushing solution (HBSS), and the fixing solution is ready to use. (B) After wetting the coat of the mouse with ethanol, the skin is pulled up and an incision is made. (C) The skin is cut laterally to get access to the chest. (D) The diaphragm is opened and (E) the chest is opened by cutting the ribs laterally. Then it is bent forward and fixed with a needle. (F) Now the heart is freely accessible. (G) A needle is inserted into the left ventricle and a cut is made in the right atrium. (H) The mouse is perfused with 10   ml warm HBSS to clear the blood vessels and then with 70   ml fixing solution.
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Remove the skin by making a transversal cut just below the diaphragm; cut through the diaphragm just at the very edge of the chest, open the chest with two lateral cuts; bend the chest backward and fix it with needles to allow a good access to the heart (Suppl. Fig. 1B–F).

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Insert a needle (27-gauge winged infusion set) into the left ventricle. Control the position of the needle so that it should not injure the aorta. Make a small cut into the right atrium ( Suppl. Fig. 1G and H).

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Perfuse with warm PBS or HBSS (approximately 10   ml) to clear the blood vessels.

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Replace the flushing solution with the fixative without introducing any air bubbles into the system; perfuse with approximately 70   ml of the fixative solution at room temperature. The mouse will jerk briefly and then become stiff.

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Dissect out the eyes, optic nerves, and brain under the stereomicroscope (see below).

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Place the tissue samples immediately into vials that contain cold fixative.

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Store the tissue at 4°C until needed. For prolonged storage, the fixative should be replaced by 1% formaldehyde; otherwise, the tissue will get very hard and brittle over time.

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Armamentarium

In Sedation (Sixth Edition), 2018

Needle Maintained in the Vein Without Continuous Infusion

When the needle is maintained in the vein without an infusion, the tourniquet is placed, the veins are engorged, and the tissues are prepared in the usual manner. A winged infusion set or a hollow metal needle is used for venipuncture. Following successful venipuncture, the tourniquet is removed, and the syringe (without a needle attached) is connected to the needle that has been left in the vein and taped into place. After the drug is titrated to effect, the syringe is detached from the needle, and a second syringe containing a solution such as sterile water for injection is attached to the needle. The dental procedure is begun, with the dentist or assistant periodically flushing the needle with 1 mL of solution to keep the vein patent ( Fig. 22.2).

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Physical Examination, Diagnosis, and Common Clinical Procedures

Monika Burns , Lynn Wachtman , in The Common Marmoset in Captivity and Biomedical Research, 2019

Other Sample Collection

As in other species, cerebrospinal fluid (CSF) is collected from the cisterna magna or from the lumbar subarachnoid space. For collection from either location, marmosets are anesthetized, the hair over the collection site is shaved, and the skin is aseptically prepared. In one published technique for collection from the cisterna magna, animals are placed in ventral recumbency and the head and neck are held in ventroflexion [117]. A 27 gauge needle is inserted perpendicularly, caudal to the occipital protuberance, at the point of intersection of a line drawn between the angles of the mandible and the midline. Gentle suction is applied while slowly advancing the needle until CSF is observed in the needle hub. An alternative technique for collection of CSF from the cisterna magna is described by Geretschläger et al. [141] . Anesthetized animals are held in a sitting position. Using a 25 gauge, winged infusion set, the needle is inserted in an upward direction, on midline, and at a point 8  mm distal to the occipital protuberance until the needle approaches and touches the occipital bone. The needle is then gradually redirected in a ventral direction along the bone to a position that allows puncture of the atlantooccipital membrane. Once the tip of the needle enters the cisterna magna, a 1-mL syringe is used to apply gentle suction and draw the CSF sample into the cannula. Both techniques enable collection of approximately 100   μL of CSF. Wang et al. describe a technique for performing intrathecal injections into the lumbar subarachnoid space [142]. Presumably this technique can be adapted for collection of small volumes of CSF from this site. With the marmoset in ventral recumbency, the space between the fourth and fifth lumbar vertebrae is palpated and a 30 gauge needle inserted into the space until a small sample of CSF fills the hub of the needle. Due to the small size of this species, these procedures require precision and finesse. Clinicians having the opportunity to perfect these techniques using cadavers may wish to do so.

Milk can be obtained from female marmosets during the lactation period, which generally persists for 65–90   days postparturition [143]. Using a technique described by Power et al., females are separated from their infants for 3–4   h to allow milk to accumulate within the mammary glands [144]. Following sedation with ketamine hydrochloride and administration of 2–3 IU oxytocin IM, nipples are cleansed with distilled water and milk is expressed manually into a collection vial.

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Anesthesia

William L. Chung DDS, MD , in Oral and Maxillofacial Surgery Clinics of North America, 2013

Venipuncture armamentarium and infusion pumps

Peripheral venous access is commonly achieved with one of several different angiocatheters (Fig. 5). One specific catheter system is the BD Insyte Autoguard (Becton Dickinson Infusion Therapy Systems, Sandy, Utah), which is a shielded intravenous catheter. This angiocatheter enables a surgeon to push a button on the catheter handle after the needle is inserted into the vein, instantly retracting the needle into the handle and reducing the risk of a needlestick injury.

Fig. 5. (A) BD Insyte Autoguard Catheter (BD Infusion Therapy Systems, Sandy, Utah). When pushed, white button (arrow) safely retracts needle into handle. (B) B. Braun Introcan Safety IV Catheter Winged (B. Braun Melsungen AG, Melsungen, Germany).

A winged infusion set, or butterfly needle, can be used during venipuncture for phlebotomy in patients with thin blood vessels that roll. The butterfly needle is not routinely used for the administration of intravenous fluids. If a butterfly needle is available and used because of difficult intravenous access, it may require the use of an arm board to prevent the upper extremity or hand from bending at the site of venipuncture.

A surgeon may choose to use an infusion pump to deliver intravenous medications rather than pushing intermittent boluses of the same drug (Fig. 6). Most infusion pumps provide similar safety and programmable features, such as accurate rapid occlusion detection and automated piggyback or concurrent delivery of a given drug. Some infusion pumps can also be programmed to accurately deliver intravenous fluids or blood products.

Fig. 6. Infusion pump.

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