How Do You Know if You Have Cracked Brusied

Getting Off: The Basics of Safer Injection

This chapter covers:

• Taking Control
• Mainlining (Intravenous Injection)
• Hierarchy of Rubber for Choosing Intravenous Injection Sites
• Veins vs. Arteries
• Veins vs. Nerves
• Exercises for Improving Vein Visibility
• Some Tips for "Getting Veins Upwardly"
• Muscle-Popping (Intramuscular Injection)
• Skin-Popping (Subcutaneous Injection)

This department of the manual presents information on proper injection technique (intravenous, intramuscular, and subcutaneous injection).

As  important  as  preparing  your  drugs  as  cleanly as possible is injecting them equally safely and equally carefully as possible.

This section of the transmission presents information on proper injection technique (intravenous, intramuscular, and subcutaneous injection). In addition to mastering proper injection technique, folks who inject intravenously regularly must also exist sure to practice good vein care, and everyone who injects should be enlightened of the various things they can do—similar rotating injection sites—that will help them avoid infection and maintain good health.

TAKING Control

It is extremely important for people who inject regularly —specially those who are physically dependent—to be able to set up and safely inject drugs on their own.  People may accept advantage of you lot when they know that you rely on them for getting off.  Y'all deserve to accept control over your body and what you need to do for yourself! Learn how to safely and properly inject yourself!

Learning how to inject properly, like mastering whatever other complicated activity, takes practise. After a while, you will no uncertainty be able to striking veins yous've never used before on the kickoff try, causing minimal trauma to the injection site and leaving a tiny puncture wound that barely bleeds. You will develop 'a feel' for where your veins are and how you need to position and insert your needle in order to go a expert striking.

Perhaps the safest way to learn how to inject is to have someone who knows what they're doing teach you. An experienced injector can walk you through the procedure of injecting, or possibly even demonstrate information technology, and prevent you from making any dangerous mistakes. If possible, detect someone who yous trust to mentor y'all through this process. And talk with other injectors about the various tips and wisdom nigh injecting they've picked upwards over the years.

Hopefully, in that location are things in this transmission that volition be new and helpful even to those of us who accept been injecting for a long time. However, reading about how to inject and actually doing it are two different things. If yous are new to injecting, we can but caution yous to read this manual thoroughly before you begin and to go irksome and be aware of everything you're doing. If the adventure of injecting drugs seems likewise dangerous after yous've read this booklet, deciding not to administrate drugs via injection is a harm reduction response that nosotros whole-heartedly support.

 M A I N L I N I N Yard ( INTRAVENOUS INJECTION )

Intravenous injection (mainlining), or injecting a substance directly into the bloodstream through a vein, is one of the fastest ways to deliver a drug into your arrangement. It is too the riskiest method to apply in terms of overdose (as compared to sniffing, smoking, or oral administration) considering the unabridged dose enters the trunk all at once and very apace. Injecting intravenously usually gives the user a "rush" that many people report to be extremely pleasurable, a sensation that does not occur with intramuscular or subcutaneous injection. While each injection method carries its own risks, mainlining is arguably the riskiest since it creates a straight opening between the bloodstream and the outside world. Heroin, cocaine, and amphetamine are three drugs that are commonly administered intravenously.

CHOOSING AN INJECTION SITE

People who inject drugs often have one or two favorite places to inject—sites that experience the near comfortable, are easy to access, and where you virtually always get a clean hit on your offset effort. While it may seem bad-mannered at showtime, information technology is of import to larn how to inject in other places that may not seem as comfy or accessible on your first couple of tries. If y'all keep injecting in your favorite spots over and over without letting the veins repair themselves they will go leaky, making your shot less satisfying and harder to hit; could get seriously infected; and will eventually collapse or scar so desperately that they become altogether unusable and interfere with circulation. So, information technology is very important to rotate the sites you utilise to inject. Try to use a new site for each new injection and go back to sites you've already used only after they've had fourth dimension to balance and repair themselves.

In addition to learning to inject in new places, it is also important to learn how to inject with either hand so that if the veins on i side of your body need a balance or are otherwise unusable, you lot're able to inject into the veins on the other side of your body—even if y'all need to use your non-dominant hand to practise it. The side by side fourth dimension you lot're in withdrawal and actually demand to get off merely tin't detect a vein in your usual spot, you'll be thankful yous taught yourself how to inject into the other arm!

CLEANING THE INJECTION SITE

Any time you inject intravenously, you risk pushing bacteria, fungi, and any other infection-causing microbes that are on your skin directly into your bloodstream. It is therefore extremely important to thoroughly clean your injection site prior to getting off. Booze pads piece of work well for this purpose, but be certain to wipe in only one direction and not in a circular motion which will cause the clay and germs to stay on your skin. Rubbing booze, hydrogen peroxide, or plain former lather and water or whatsoever other type of cleaning amanuensis or disinfectant also work fine. Exist sure not to touch the injection site with your fingers after you've cleaned information technology. Routinely cleaning the peel prior to injection is ane of the virtually important things y'all tin can do to reduce your risk of endocarditis, claret poisoning, and similar infections (discussed in chapter three).

TYING Upwardly

Apply gravity to bring blood to the limb you're going to employ to inject before applying your tourniquet (tie): swing or hang your arms, make a fist, etc. Tie your tourniquet in such a way that it can exist easily removed if necessary. Try to secure 'rolling' veins like those in your forearms earlier you inject into them. Finally, be certain not to leave the tourniquet on for too long. If you feel your limb becoming numb or notice information technology turning blue, undo your tourniquet and don't retie it until you're ready to inject.

INSERTING YOUR NEEDLE

Insert the needle into your vein with the needle bevel (opening) facing up, at a fifteen to 35 degree bending, and always in the direction of the center. The more than perpendicular the needle is to the injection site, the greater chance y'all have of sticking the needle through the vein instead of into it. (See illustration on following page.)

REGISTERING

One time you think you're in a vein, pull the plunger back to see if claret comes into the syringe. If so, and the blood is night ruddy and slow moving, you know that you've hit a vein. Y'all tin now untie your tourniquet and proceed to inject your drugs. If no claret or only a very tiny corporeality of blood comes into the syringe when you pull back, yous're non in a vein and will accept to untie your tourniquet, pull your needle out, and try again. If you proceed to inject without being properly positioned in a vein, you'll be putting your drugs into the tissue surrounding the vein, nether the skin, or some other identify. It volition probably be painful and become bloated, and the furnishings of your drugs will come on much more slowly. You as well take a chance abscess formation and other possible bug.

If there's likewise much blood in your shot to tell if you're properly registering, split the shot into two and dilute each one-half with water. If the plunger of your syringe is forced back past the pressure level of the blood and it is bright red, frothy, and 'gushing,' you may have hit an avenue.  Stay calm and slowly draw the syringe out and drag the limb.

Some people like to 'kick' their syringe later on they've injected their drugs—that is, pull back the plunger, draw blood into the syringe, and re-inject information technology. Some injectors like to do this several times, ostensibly to rinse out whatsoever drug solution that remains in the syringe. Considering of all the blood involved, you might want to refrain from booting if y'all know you're going to be cleaning your needle and syringe and assuasive someone else to use it. Exist sure to thoroughly flush your needle and syringe with h2o after booting if you plan to re-utilize information technology at a later time, so that blood doesn't clog the needle.

PULLING OUT

After you've successfully injected your drugs, advisedly pull the needle out of the injection site at the same angle at which it went in. (To minimize bruising, y'all should have untied your tourniquet before yous injected your shot.) Utilize pressure level to the injection site to stop whatever bleeding. If you're getting off in a public place, it is a skilful idea to have some tissue, gauze, or Band-Aids effectually then yous don't get blood all over your clothes. Don't use booze pads on a fresh injection wound: alcohol volition cause it to bleed more, non less.

MISSED SHOTS & AFTERCARE

Don't utilise creams, salves or oils you apply to treat your track marks or bruising until the injection wound has begun to close (a couple of hours after injecting) otherwise yous might cause an infection. Treat missed shots (those that ended upwards somewhere other than in your vein) immediately with a warm water soak or compress to reduce the likelihood of irritation and abscess formation. Warmth will open the capillaries and bring disease-fighting white claret cells to the affected area.

MAINLINING COCAINE

Cocaine has a numbing effect on the veins and causes them to tuck (shrink), so if yous're shooting coke, you should be extra careful to register properly and make sure you're in a vein before y'all inject your drugs. Too, chances are that if you're shooting coke, you'll be injecting many times in a curt period of fourth dimension with peradventure but several minutes between each injection. This tin can be traumatic on the veins and the surrounding tissues, and effect in a lot of bleeding.

• Try to use a sterile, abrupt needle for each injection;
• brand certain yous proceed your injection equipment separate from anyone else'southward you're getting off with;
• and try to give the area a adept balance for a few days.

You may experience some pain and swelling after such intense action.

MAINLINING Crack

Considering cleft comes in a solid grade (stone), it is necessary to dissolve it beginning. The safest mode to practise this is with powdered citric or ascorbic acid–ask your local syring service plan or health nutrient shop where to discover information technology. Avert lemon juice or vinegar, as these tin can lead to serious infections.

To dissolve crack: put crack and citric or ascorbic acid (about a pinch to a slab) in the cooker; add plenty of water; brew and mix well.  Attempt to merely utilise as much acid as yous need, since extra will dissolve your drugs, and acid can exist very difficult on your veins.

SHOOTING SPEED

Because speed is often cut with such unsafe chemicals, it is very important not to miss your shot. Pare-popping speed can exist very painful, may cause an abscess, and will accept a long time for the body to absorb. If you become the shakes after doing a few shots, it may be helpful to accept a friend inject y'all if you lot are non using alone. Considering the quality of speed varies and so dramatically, a tester shot is a good idea.

Hierarchy OF SAFETY

for Choosing Intravenous Injection Sites

The following is a breakdown of possible intravenous injection sites, beginning with the safest options and moving toward the least safe ones.

Artillery: Artillery, outset upper then lower, are the safest sites for injecting. Y'all should be careful to secure the 'rolling' veins in the forearms before you inject into them. Arms are also good if you're concerned virtually hiding your injection or rail marks (although wearing long sleeves in the summertime can be a drag!).

Easily: Easily are somewhat less rubber than arms considering the veins are significantly smaller and more than delicate and therefore more than likely to bruise or go damaged. Apportionment is also slower in the easily, causing healing to take longer. If you're getting off in your hands, be sure to use the thinnest needle possible (highest gauge) or, if you can find one, a butterfly needle. Be vigilant nearly rotating the sites, and go along in mind that it is difficult to conceal injection marks and bruises on the hands.

LEGS: Circulation in the legs may be poor, especially in people who don't use theirs a lot. Veins in the legs are more likely than those in the artillery to develop clots that tin obstruct circulation and eventually break off and club in the lungs or heart. Likewise, damaging the valves in the leg veins is more than serious than damaging those in the artillery since they play a greater role in getting blood back to the heart.

FEET: As with the hands, the veins in the feet are generally smaller than in other parts of the body, and close to nerves, cartilage, and tendons which y'all want to avoid striking when yous inject. Considering they are farther from the middle than the veins in the hands, artillery, and legs, blood circulates more than slowly in the foot veins and they therefore require more time for healing and repair. In improver, human foot sweat and dirty socks act to prevent wounds from healing and increment the hazard of infection from leaner.

GROIN: The femoral vein in the groin area is a big and adequately easy vein to access, but its location near the femoral nervus and the femoral artery get in quite a risky place to inject. Among the three, the femoral vein is located closest to the groin, with the artery and and then the nerve located as you move outward. If you're going to inject into the femoral vein, offset locate your femoral avenue— where yous exercise not want to inject—by finding the pulse. So move a curt distance toward the inside of your leg to find the femoral vein. Because it lies fairly deep, yous volition probably not be able to run into it but will have to inject into it without seeing where the vein is.

NECK : The jugular vein in the neck is the riskiest place to inject because it lies very shut to the carotid artery, a major blood vessel that brings blood directly to the encephalon. Accidentally striking the carotid artery could be fatal, and damaging the jugular vein in any way can interfere with blood circulation to the brain.

SAFEST INJECTING LOCATION: THE ARM

(Numbered in order of safe)

LOCATION OF VEINS IN Hand:

Know Where You're Striking

 More than TIPS FOR CHOOSING AN APPROPRIATE INJECTION SITE

• Taking proper care of the veins in your arms and other safer locations volition prevent you from having to shoot up in more than dangerous ones.
• You should avoid using veins that are tender, hardened, or inflamed until (and if) they heal. Warm compresses and the use of appropriate creams can assistance speed the healing process.
• The larger and more visible the vein, the easier and safer it usually is to hit. Deep veins are harder to hitting, and trying to access them increases your take a chance of hit a nervus or artery in the procedure. On the other mitt, it may be difficult to go on a needle properly positioned in a very shallow vein, causing you to accidentally pare-popular your hit.
• Areas that are farthest from the heart, like the easily and feet, heal the slowest and take the poorest circulation. Areas nearest to the heart (like the groin and the neck) have veins that are located near major arteries and nerves which, if accidentally striking, tin cause serious, life-threatening damage.
• Injecting almost a bone increases the chances that swelling and pain will occur.

VEINS VS. ARTERIES

You always want to inject into a vein and never into an artery. Veins are blood vessels that carry blood from the extremities of the torso dorsum to the heart and lungs where it becomes re-oxygenated. Veins have no pulse, and the blood they carry is a deep, dark red because it is depression in oxygen. Arteries carry blood rich in oxygen from the lungs and heart to all the other parts of the body. Arteries have a pulse, and the blood in them is bright red and frothy. Arteries are located deeper in the torso than veins and and then are not visible as many of your veins are.

You'll know you lot hit an artery if:

• The plunger of your syringe is forced back by the force per unit area of the blood.
• When you lot register, the blood in your syringe is bright red and 'gushing.' Blood in veins is dark crimson, slow-moving, and "lazy."
• It hurts differently from your usual injections

You can avoid hit an artery by:

• Never injecting where y'all experience a pulse.
• Injecting only into surface veins and non trying to hit those that lie deeper.

What to do if you hit an artery:

• Untie your tourniquet and pull your needle out immediately.
• Enhance the limb above your caput to stop the bleeding, if possible.
• Utilise business firm pressure to the wound for at least 10 minutes.
• If bleeding continues, apply a bandage or fabric wrapped very tightly around the wound and seek medical attending immediately. The loss of blood from hitting an avenue tin can be life-threatening if it'south not stopped.

Veins vs. Nerves

Unlike some veins, nerves are not visible from outside the body, although you volition definitely know if yous've hitting one while injecting because y'all'll experience extreme hurting and no blood will enter the syringe when y'all pull back to register. You may experience an electric "burn down" along your limb.

 Hitting a nerve can be very dangerous and result in paralysis or the loss of a limb. It'due south a skilful idea to know where your major nerves are and so that you tin can avoid them when getting off.

Exercises for Improving Vein Visibility

If you lot're the athletic type, engaging in the following activities can help brand your veins more visible from outside the body.

• Push-ups, pull-ups, and other exercises that strengthen the arms
• Weight-lifting, peculiarly bicep exercises
• Squeezing lawn tennis assurance
• Wrist curls

Some tips for "Getting Veins Upwardly"

If you're having difficulty locating a vein to inject into, y'all might want effort one of the following:

• Put a warm compress on your injection site for 5 or ten minutes to aid bring a vein to the surface. When you're cold, it tin exist very difficult to admission a vein. (If you're getting off in a bath or somewhere else where there's not a lot of heat, don't unroll your sleeve or uncover your injection site until you're ready to inject.)
• Lower your arms below your middle or swing them in a circumvolve.
• Lightly slap the injection site.
• Wrap your limb in Saran Wrap for a few minutes. This traps the estrus and causes veins to ascension to the surface.
• Caffeine and nicotine tin can both tuck veins. Attempt injecting before you've had your start cup of coffee and/or cigarette. If y'all have had a loving cup of java or a cigarette, wait about xxx minutes to try injecting again.
• Remain calm. It tin be extremely frustrating to be unable to go a hitting, especially if yous're in withdrawal. Chances are getting upset will merely increase your difficulty, then take a few deep breaths and showtime over again in a calmer state of listen.

 Musculus – POPPING ( INTRAMUSCULAR I N J EC T IO N )

Some drugs, including injectable steroids and hormones, must exist injected into a muscle instead of a vein, merely heroin and other opiates can also be administered using this method. The physical and psychoactive effects that effect from an intramuscular injection of a drug come up on much more slowly than those of an intravenous injection (half an hour to forty-five minutes versus well-nigh immediately), although the overall, cumulative intensity of the effects and the experience are almost identical. Besides, the "blitz" that is produced when drugs like heroin are administered intravenously is not experienced by individuals who inject intramuscularly.

Almost if non all of the infection control and other rubber precautions intravenous drug injectors should follow also apply to individuals who inject drugs intramuscularly. Muscle-popping produces much less bleeding than intravenous injection, if whatever at all, only the take chances of transmitting viruses and other blood-borne bacteria every bit a event of needle-sharing is equally serious equally it is with intravenous injection. In improver, muscle-poppers are at high take a chance for abscess formation, especially if what they inject has any particles in information technology whatsoever. When musculus-popping, information technology is extremely important to inject only a solution that is every bit particle-complimentary every bit possible.

Many of the substances that crave intramuscular injection come pre-prepared in liquid class. To prevent contaminating your entire supply (especially if you're sharing it with someone else), exist sure to use only a sterile needle and syringe when drawing the liquid upward from the bottle in which it'due south stored. Muscling speed or cocaine is very painful and dangerous, and is likely to crusade an abscess.

CHOOSING AN INJECTION SITE

The buttocks, thighs, and upper artillery are the iii best sites, respectively, for intramuscular injection. The all-time is in the deltoid, the muscle on your upper, outer arm where your shoulder and your arm come across. If injecting into the barrel, mentally divide each cheek into four equal sections and inject into the top right or top left outer section of each cheek. Yous can also use the front surface of your thighs well-nigh vi inches higher up your genu to well-nigh six inches beneath your hip, or the outer surfaces of your upper arms between your shoulder and your elbow. Always be careful to avoid fretfulness, blood vessels, or bones, and rotate injection sites to avoid bruising, abscess formation, and the like. It is non uncommon for your muscle to be sore for a few days after an injection.

CLEANING THE INJECTION SITE

Be sure to carefully clean the injection site prior to injecting (meet 'Mainlining' department higher up for more than detail).

INSERTING THE NEEDLE

Try to relax the muscle prior to injection. This will consequence in a less painful injection and may prevent the soreness you ordinarily feel the post-obit mean solar day or two. When injecting into a musculus, insert the needle in one quick stab straight into the injection site at a 90° bending to the body. Nearly the unabridged needle should enter the muscle. You definitely want to draw your plunger dorsum slightly to make sure no blood comes into the syringe. If claret does announced, you lot've hit a blood vessel and demand to pull out and effort once more. Inject your substance slowly.

PULLING OUT

Pull your needle out in the same management and angle at which you inserted it. Considering you injected into a muscle, there should be niggling if any haemorrhage. You lot might want to utilise a Ring-Aid in whatever case to forestall infection. Massaging the area lightly for a few minutes will aid the drug blot and reduce the pain.

MUSCLING HORMONES

Hormones are to exist injected only into the thigh or buttock muscle. When injecting, exist careful of nerves, veins, and bones. The buttock is the most common identify people inject. You can switch buttock cheeks to avoid bruises and sores. Subsequently you lot inject into these muscles, yous might be sore for a day or two.

Do not inject more than the prescribed amount; it will not speed upward your treatment process. You can cause serious liver damage and increase the risk of blood clots. Blood clots tin can appear in the veins of the legs and can travel to the lungs; this is chosen Pulmonary Embolism, which can exist fatal. People who fume cigarettes and inject hormones are more likely to develop Pulmonary Embolism. (This section taken from Positive Health Projection's "Safety Guidelines for Injecting Hormones.")

 S K I N – P O P P I N G ( S U B C U T A Due north East O U S I Northward J E C T I O North )

Pare-popping is the injection of drugs betwixt the trunk'south peel and fat layers. Like muscle-popping, the effects of your drug volition come up on much more slowly than if you lot'd injected it intravenously, and you will non experience a "rush."

Pare-poppers should follow all of the infection control and other safety precautions that intravenous and intramuscular injectors should follow. Although like with muscle-popping, skin-popping results in little or no bleeding at the site of the injection, the risk for bacterial or viral infection is real if injection equipment is shared or drugs are not prepared and injected hygienically. Also, peel-poppers are at greatly increased risk for abscesses, especially if injecting crushed pills or another solution with particles in it. When skin-popping, it is critical to use simply a solution that is as particle-gratis every bit possible.

CHOOSING AN INJECTION SITE

The upper and lower arms and legs are probably the all-time locations for pare-popping.

CLEANING THE INJECTION SITE

As always, thoroughly clean the injection site with alcohol, lather and h2o, or other disinfectant prior to injection.

INSERTING THE NEEDLE

Slide the needle under your skin at a shallow bending, xv° to 45°  at  the  most. Inject  no  more  than  1⁄2   cc  of  liquid  (half  of  the book of a 1 cc syringe) to form a little bubble under the pare. If  your  hit  is  more  than  i⁄2   cc, inject  into  two  or  more  sites. The bump from the solution you injected will slowly decrease equally the liquid is absorbed into the body, and should disappear completely within a few hours. Pare-popping can be uncomfortable, and the bump you create may hurt a flake. If you lot peel popular where the skin is loose, pinch the peel between your pollex and forefinger and put the needle into the skin you lot've pulled up.

PULLING OUT

Pull your needle out in the same management as it went in. There should non exist much bleeding at the injection site when skin-popping, only yous might want to apply a Rough-and-tumble to preclude infection.

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Source: https://harmreduction.org/issues/safer-drug-use/injection-safety-manual/safer-injection-basics/