Safer injection guide: Difference between revisions

{{#ev:youtube|https://www.youtube.com/watch?v=MppHWdZ-S_I|340x240|right|[[#Sterile single-use spoon|Sterile single-use spoons]] for preparation of drugs for injection complement [[#Sterile syringe and sterile hypodermic needle|sterile syringes and sterile hypodermic needles]] in preventing transmission of blood-borne diseases, which often goes unnoticed through communal pools: ''Boiling, burning, or using common cleaning fluids, alcohol, or peroxide can reduce the amount of the hepatitis C virus (HCV), but this may not prevent you from getting infected.''<ref>https://www.cdc.gov/hepatitis/hcv/pdfs/factsheet-pwid.pdf</ref> The [[Sharing_injection_materials#Hepatitis_C|hepatitis C]] virus can survive outside the body for <span style="color:red">'''6 weeks'''</span>.<ref name="pmid24273176" /> The international prevalence of {{nowrap|hepatitis C}} is between <span style="color:red">'''60% and 80%'''</span> among people who use injection drugs.<ref name=Lancet2011>{{cite journal | vauthors = Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L | title = Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews | journal = Lancet | volume = 378 | issue = 9791 | pages = 571–83 | date = August 2011 | pmid = 21802134 | pmc = 3285467 | doi = 10.1016/S0140-6736(11)61097-0 }}</ref><ref name=China2008>{{cite journal | vauthors = Xia X, Luo J, Bai J, Yu R | title = Epidemiology of hepatitis C virus infection among injection drug users in China: systematic review and meta-analysis | journal = Public Health | volume = 122 | issue = 10 | pages = 990–1003 | date = October 2008 | pmid = 18486955 | doi = 10.1016/j.puhe.2008.01.014 }}</ref> Hepatitis C cannot be prevented once the virus has already been introduced into the body, and currently, there is no vaccine.|frame}}

'''Injection''' is the act of delivering a [[psychoactive substance]] into the body using a hypodermic needle. Injected substances are mixed with a liquid (such as [[#Sterilie water for injection|sterilie water for injection]]) to form a solution, which is usually either injected directly into the bloodstream via the veins (i.e. intravenous or [[#IV_injection|IV injection]]) or into the muscle tissue (i.e. intramuscular or [[#IM_injection|IM injection]]).

*'''Nerve damage''' - Injecting into the muscle tissue during an IM injection, missing a vein during IV injection, and SC injecting can all present the risk of nerve damage. The hypodermic needle may puncture a nerve and cause serious, painful, and possibly fatal bodily harm. This risk is especially present if injecting into the groin, as the femoral nerve located there controls leg and muscle movement - '''damaging this nerve can result in serious problems with mobility or even paralysis.'''<ref name="3-Potentially-Deadly-Spots"/>

*'''Injecting into the wrong tissue''' - Some substances need to be injected into certain types of tissue in order to be effective. For example, [[heroin]] is most potent when IV'd and can be extremely harmful when injected into the subcutaneous tissue. [[Ketamine]], however, is typically IM'd. It is vital to ensure that one's hypodermic needle is correctly inserted into the vein before proceeding with an I.V injection.

 

 

* [[Sharing_injection_materials#Hepatitis_B|Hepatitis B]] virus (HBV): 7 days<ref>https://www.cdc.gov/hepatitis/hbv/bfaq.htm</ref>

* [[Sharing_injection_materials#Hepatitis_C|Hepatitis C]] virus (HCV): <span style="color:red">'''6 weeks'''</span>.<ref name="pmid24273176">{{cite journal |last1=Paintsil |first1=E |last2=Binka |first2=M |last3=Patel |first3=A |last4=Lindenbach |first4=BD |last5=Heimer |first5=R |title=Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. |journal=The Journal of infectious diseases |date=15 April 2014 |volume=209 |issue=8 |pages=1205-11 |doi=10.1093/infdis/jit648 |pmid=24273176 |pmc=3969546}}</ref><!-- Added to: Safer_injection_guide, Sharing_injection_materials -->

===Sterile water for injection===

 

 

 

 

===Sterile single-use spoon===

Typically, a small disposable aluminum single-use spoon, ideally color-coded, specifically designed for the purpose of dissolving and sterilizing the substance for injection.

====Risk of shared, non-sterile reservoirs====

 

===Sterile syringe and sterile hypodermic needle===

[[File:Rig.png|300px|thumb|right|The full injection set up is shown above. The hypodermic needle is the part that penetrates the skin, the barrel is the part that contains the drug solution, the plunger is pulled to check if one is in a vein and pushed down upon injection.]]

====Sterile syringe with sterile intravenous hypodermic needle====

Used for IV injection. Insulin syringes (with cemented hypodermic needles) are common, but 1-2 mL syringes with short hypodermic needles (0.5 inch (13 mm), and 14-30 G) are also used (e.g. "tuberculin syringes"), meant to penetrate surface veins.

Drug users typically use a 25 g rapid (5-16 seconds) intravenous injection by arm via the median cubital vein to get a [https://en.wikipedia.org/wiki/Rush_(psychology) rush]. However, smaller gauges such as 30 g can be used to prevent a vein collapse for repeated administration. Hypodermic needles smaller than 30 G are normally used for subcutaneous injection, but not for intravenous (coagulated blood immediately after blood response) or intramuscular use (the finest hypodermic needles are very short).

====Sterile syringe with sterile intramuscular hypodermic needle====

[[File:Needle length diagram.png|300px|thumb|left|IM hypodermic needles are longer than IV hypodermic needles.]]

This type of syringe is used for the less common intramuscular (IM) injection. The syringes are typically 1 mL to prevent slow injection, and the hypodermic needles typically has a hole size of 22-25G, and are typically 1- to 1.5-inch (25–38 mm, and up to 3 inch (76 mm) for large adults) depending on body weight, which is longer than the traditional insulin needles seen for IV use because it is designed to penetrate deep into the muscular tissue instead of a vein.

====Solution for injection====

[[#Sterile water for injection|Sterile water for injection]] (SWFI) should be placed in a [[#Sterile single-use spoon|single-use spoon]] when substances for injection are dissolved, in order to avoid spreading blood-borne diseases.

=====Procedure=====

#The hypodermic needle will most likely have a bevel. It is important to angle the beveled edge away from the skin, so the point of the needle penetrates the vein and injects.

#Once you have penetrated the skin, and it feels that you have punctured the vein with the hypodermic needle: Pull back on the plunger of the syringe, or hold the syringe vertically, so the blood can flow into it. If there is blood present in the syringe, the needle has hit a vein, and it is good to inject. If there is no blood in the syringe barrel or one feels a suck back, '''the needle is not in a vein; it is in subcutaneous tissue, so do NOT inject! Repeat the former ''venipuncture'' steps until the needle hits a vein.'''

#Once the hypodermic needle is in the vein, push the plunger down ''GRADUALLY'' for at least 30 seconds. It is highly advised not to rush the injection, especially if one is IVing a strong [[opiate]], such as [[heroin]]. However, leaving the needle in the vein for a long time can cause it to be irritated.

#Once all the solutions have been injected, slowly remove the hypodermic needle.

======Foot injection======

*'''Hypodermic needle length''' - It is important that one uses a hypodermic needle that is longer than the IV needle in order to reach the muscle tissue.

#To prepare the hypodermic needle, hold the syringe with the dominant hand and pull the cover off with the other hand. Place the syringe between the thumb and first finger.

#Hold the syringe barrel tightly and use the wrist to inject the hypodermic needle through the skin and into the muscle at a 90-degree angle.

#Let go of the skin with the other hand. Hold the syringe, so it stays pointed straight in. Pull back on the plunger a little to make sure the hypodermic needle did not hit a blood vessel. The point of intramuscular injection is to inject within the muscle itself. '''If blood comes back into the syringe barrel, remove the needle immediately and do not inject.''' If possible, dispose of the needle and syringe and get a new one. When giving the second injection, use a different injection site than the first.

#Once the solution is injected, remove the hypodermic needle at the same angle as it went in. Re-swab the area of injection with an alcohol swab.

'''<span style="color:red">Warning: This method of injection is uncommon and is not advised. The hypodermic needle may break off in the skin, hit a nerve, or cause scarring, lumps, and other skin problems. Additionally, the risks of infection are greatly increased when using this method of administration.</span>'''

*'''Hypodermic needle type''' - An IV or insulin hypodermic needle length is suitable for this type of injection. Do not use a longer needle length as it can penetrate other types of tissue and cause medical problems.

#Insert the hypodermic needle into the skin and slightly pull the plunger back. No blood should enter the syringe barrel to ensure that you are in subcutaneous tissue.

#Slowly inject the substance into the subcutaneous tissue.

#Remove the hypodermic needle at the same angle that it entered and re-wipe the injection site with an alcohol wipe.

In order to prevent the spread of blood-borne diseases and bacterial infections, <span style="color:red"><b>clean up and dispose of used hypodermic needles and syringe barrels properly</b></span>. The needle and barrel of the syringe can hold old blood, that can harbor viruses.

Single-use spoons are made of thin metal sheets, which make them easy to press together to indicate that they have been used.

One should always re-cap their '''own''' old hypodermic needle after injection to ensure that other people are not exposed to the old blood that still resides in the needle. The needle can and will cause accidental skin pricks that transmit disease. '''Do not let others re-cap someone's own used needle!'''

However, if you don't have access to a sharps disposal container, please collect the syringes and hypodermic needles in a puncture and leak-resistant plastic container, and leave it to your drug store as soon as possible.  

Don't flush residues from the hypodermic needle and syringe in a glass of water and leave publicity available. Blood residues can fool someone to think it's actually squash and drink from it (yes, for real). Also, glass or other containers, contaminated with blood, can cause blood-borne diseases when used by others. It's safer to flush the syringe and needle under an interior water tap in the sink, as long as they don't get in touch with it.

* [[Sharing_injection_materials#Hepatitis_C|Hepatisis C virus]] (HCV): Sterilizing hypodermic needles using bleach, boiling water or alcohol may not kill HCV.<ref>{{cite journal |last1=Mukherjee |first1=TI |last2=Pillai |first2=V |last3=Ali |first3=SH |last4=Altice |first4=FL |last5=Kamarulzaman |first5=A |last6=Wickersham |first6=JA |doi=10.1016/j.drugpo.2017.05.041 |pmid=28652072 |pmc=5592150}}</ref> So it is not advised to share cooking pans to sterilizing equipment.

*'''[https://en.wikipedia.org/wiki/Hypodermic_needle Hypodermic needles] and syringes''' - Hypodermic needles and syringes are illegal to possess without a prescription in some states,<ref>{{Citation | title=Syringe Distribution Laws | url=https://lawatlas.org/datasets/syringe-policies-laws-regulating-non-retail-distribution-of-drug-parapherna}}</ref> and countries.