Safer injection guide: Difference between revisions

Line 39:

*'''Stroke risk''' - Injecting into an artery and not a vein can be a potential cause of strokes and blood embolisms. This risk is especially present with IV drug use, when one misses a vein and injects into the artery instead. This is why it is important to make sure '''one is in a vein before IV injection'''. This risk increases with the use of uncommon injection sites such as the neck: the chemicals being injected might enter an artery and go straight to the brain, causing neurological problems and strokes.<ref name="3-Potentially-Deadly-Spots">{{Citation | year=2015 | title=IV Injection Sites - Potentially Deadly Spots to Shoot Up | url=https://drugabuse.com/blog/iv-drug-abuse-3-potentially-deadly-spots-to-shoot-up/}}</ref>

*'''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 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"/>

*'''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"/>

*'''Deep Vein Thrombosis (DVT)''' - Deep vein thrombosis is a blood clot occurring in the deep arms of the legs and extremities, especially the legs.<ref>{{Citation | title=Deep Vein Thrombosis (DVT) Symptoms, Treatment, Causes, Diagnosis | url=https://www.medicinenet.com/deep_vein_thrombosis/article.htm}}</ref> This is a risk that is especially present with IV drug use into the groin are and the deep veins in the arm. Signs of deep vein thrombosis include; pain, swelling, redness, or tenderness of the leg or arm around the injection site. IV drug use leads to a higher rate of DVT in younger patients, with most DVT issues occurring in the groin area and the thigh.<ref>{{cite journal | vauthors=((Cornford, C. S.)), ((Mason, J. M.)), ((Inns, F.)) | journal=The British Journal of General Practice | title=Deep vein thromboses in users of opioid drugs: incidence, prevalence, and risk factors | volume=61 | issue=593 | pages=e781–e786 | date= December 2011 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223775/ | issn=0960-1643 | doi=10.3399/bjgp11X613115}}</ref>

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*'''[https://en.wikipedia.org/wiki/Extravasation_(intravenous) Extravasation]''' - Extravasation is the leakage of intravenously (IV) infused, and potentially damaging, medications into the extravascular tissue around the site of infusion. Extravasation of medication during intravenous therapy is an adverse event related to therapy that can potentially cause serious injury and permanent harm, such as tissue necrosis.

*'''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 needle is correctly inserted into the vein before proceeding with an I.V injection.

*'''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.

===Virus survival time outside the body===

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* Distilled water should be avoided in large amounts directly into a vein, as it can cause your blood cells to become hypotonic, possibly leading to death.

* Hot tap water should always be avoided because it contains heavy metals.

* Boiled tap water: It is also important to change the water at a regular interval to prevent bacteria growth within the water. Be mindful that using multiple needles in the same water supply can easily spread illness and disease. No other liquid substance should be added to the injection, even if it is supposed to increase the solubility of the drug in the water solution. Heat can be used to aid dissolution, but fruit juice or vinegar can lead to infections.

* Boiled tap water: It is also important to change the water at a regular interval to prevent bacteria growth within the water. Be mindful that using multiple hypodermic needles in the same water supply can easily spread illness and disease. No other liquid substance should be added to the injection, even if it is supposed to increase the solubility of the drug in the water solution. Heat can be used to aid dissolution, but fruit juice or vinegar can lead to infections.

Water for injection can also be used for [[Nasal spray guide|nasal sprays]], and eye drops.

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

[[File:Rig.png|300px|thumb|right|The full injection set up is shown above. The 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.]]

[[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.]]

About 0.1 mL of the solution is lost in conventional syringes through the [https://en.wikipedia.org/wiki/Luer_taper Luer taper] tip and the Luer taper adapter of the hypodermic needle. That can be compensated by either adding extra 10% or 5% substance in 1 mL or 2 mL syringes respectively, or by using [https://en.wikipedia.org/wiki/Low_dead_space_syringe low dead space syringes].

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

Used for IV injection. Insulin syringes (with cemented 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.

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 needles are very short).

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|An IM ~~needle differs from an~~ IV ~~needle in length~~.]]

[[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 ~~needle~~ 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.

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.

"It is common to have muscle pain when injecting larger doses of liquid Ketamine into muscle tissue. The pain can continue for several days if it is not administered properly. The muscle soreness can be somewhat controlled by using a very fine (small gauge) needle and by injecting very slowly. It should take 15-30 or more seconds to inject a dose into a muscle. If you feel it begin to sting, slow down the injection rate."<ref>{{cite web |title=Erowid Ketamine Vault : Dosage |url=http://www.erowid.org/chemicals/ketamine/ketamine_dose.shtml#im |website=www.erowid.org}}</ref>

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#If using the traditional crook of the elbow injection site, one may need to apply pressure above the vein to make the vein stick out more. This is typically achieved through "tying off," which refers to the practice of wrapping a solid band or tourniquet around the upper forearm so that blood constricts and the veins become more visible.

#Take three deep breaths.

#The 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.

#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.

#[https://en.wikipedia.org/wiki/Venipuncture Venipuncture]: However, for typical injection in the arm, penetrate the skin at a 15 to 35-degree angle and always inject toward the heart. Avoid to push the hypodermic needle deeply into the vein to avoid [https://en.wikipedia.org/wiki/Extravasation_(intravenous) extravasation] which can serious injury and permanent harm, such as tissue necrosis.

#Once you have penetrated the skin, and it feels that you have punctured the vein with the 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 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 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 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 needle.

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

#Block the bleeding from the vein by gently pushing a piece of toilet paper on it for approximately 20 seconds.

#Use a new alcohol swab to clean the injection site. There may be a little blood.

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</center>

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

*'''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 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.

#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 skin around where the injection will be administered. With the free hand, gently press on and pull the skin so that it is slightly tight.

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

#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 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.

#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.

#Push down on the plunger to inject the solution. Do not push the plunger down hard and fast; some substance solutions may burn. Injecting at a slower rate reduces the pain.

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

#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.

====SC injection====

[[File:SC injection skin pinch.jpg|300px|thumb|left|Hold and pinch the skin to inject into the subcutaneous tissue.]]

'''Warning: This method of injection is uncommon and is not advised. The 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.'''

'''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.'''

*'''~~Needle~~ type''' - An IV or insulin 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.

*'''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.

*'''Administration sites''' - The areas where SC injections can be administered in are the abdomen, the thigh, the lower back, and the upper arm.<ref>How To Give A Subcutaneous Injection (drugs.com) | https://www.drugs.com/cg/how-to-give-a-subcutaneous-injection.html/</ref> It is important to vary the injection site to avoid infections or injuries. Seek immediate medical care if a rash develops at the injection site or swelling is present after injecting.

#Hold the syringe in the dominant hand and grasp and pinch the skin where one will administer the SC injection.

#Inject the 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.

#Inject 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 (skin) tissue.

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

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

==Cleaning up after injection==

In order to prevent the spread of blood-borne diseases and bacterial infections, clean up and dispose of used needles and syringe barrels properly. The needle and barrel of the syringe can hold old blood, that can harbor viruses.

In order to prevent the spread of blood-borne diseases and bacterial infections, clean up and dispose of used hypodermic needles and syringe barrels properly. The needle and barrel of the syringe can hold old blood, that can harbor viruses.

===Sterile single-use spoons===

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===Hypodermic needles===

One should always re-cap their '''own''' old 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!'''

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!'''

After the needle has been re-capped, it should be disposed of properly. Take the used needle and syringe to a medical waste/sharps disposal facility near you. Do not simply leave the needles lying around as this makes them available for re-use by others and is a possible vector for disease. Leaving needles lying around, especially if they are uncapped, also leads to an increased risk of accidental skin pricking which can cause injury, infection, or disease.

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You'll find sharps disposal containers in your local drug store, often offered gratis. They are also offered in needle exchange programs.

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

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.

===Biological residues===

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Sterilizing capacity of an autoclave:

* [[Sharing_injection_materials#Hepatitis_C|Hepatisis C virus]] (HCV): Sterilizing 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.

* [[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.

Sterilizing capacity of an autoclave or pressure cooker:

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The injection of illegal drugs may lead to a higher risk of legal consequences. These consequences differ by country, state, and county. One should research the laws in their region before choosing to inject.

*'''~~Needles~~ and syringes''' - ~~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.

*'''[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.

*'''Overdoses''' - If someone overdoses, the person who stays with them and calls emergency medical services will not be prosecuted. Do not simply leave a person who has overdosed to die out of fear of legal repercussions. The legal repercussions of staying with someone that has experienced [[drug overdose]] and calling emergency medical services vary by location.

@@ Line 39: / Line 39: @@
 *'''Stroke risk''' - Injecting into an artery and not a vein can be a potential cause of strokes and blood embolisms. This risk is especially present with IV drug use, when one misses a vein and injects into the artery instead. This is why it is important to make sure '''one is in a vein before IV injection'''. This risk increases with the use of uncommon injection sites such as the neck: the chemicals being injected might enter an artery and go straight to the brain, causing neurological problems and strokes.<ref name="3-Potentially-Deadly-Spots">{{Citation | year=2015 | title=IV Injection Sites - Potentially Deadly Spots to Shoot Up | url=https://drugabuse.com/blog/iv-drug-abuse-3-potentially-deadly-spots-to-shoot-up/}}</ref>
-*'''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 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"/>
+*'''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"/>
 *'''Deep Vein Thrombosis (DVT)''' - Deep vein thrombosis is a blood clot occurring in the deep arms of the legs and extremities, especially the legs.<ref>{{Citation | title=Deep Vein Thrombosis (DVT) Symptoms, Treatment, Causes, Diagnosis | url=https://www.medicinenet.com/deep_vein_thrombosis/article.htm}}</ref> This is a risk that is especially present with IV drug use into the groin are and the deep veins in the arm. Signs of deep vein thrombosis include; pain, swelling, redness, or tenderness of the leg or arm around the injection site. IV drug use leads to a higher rate of DVT in younger patients, with most DVT issues occurring in the groin area and the thigh.<ref>{{cite journal | vauthors=((Cornford, C. S.)), ((Mason, J. M.)), ((Inns, F.)) | journal=The British Journal of General Practice | title=Deep vein thromboses in users of opioid drugs: incidence, prevalence, and risk factors | volume=61 | issue=593 | pages=e781–e786 | date= December 2011 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223775/ | issn=0960-1643 | doi=10.3399/bjgp11X613115}}</ref>
@@ Line 49: / Line 49: @@
 *'''[https://en.wikipedia.org/wiki/Extravasation_(intravenous) Extravasation]''' - Extravasation is the leakage of intravenously (IV) infused, and potentially damaging, medications into the extravascular tissue around the site of infusion. Extravasation of medication during intravenous therapy is an adverse event related to therapy that can potentially cause serious injury and permanent harm, such as tissue necrosis.
-*'''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 needle is correctly inserted into the vein before proceeding with an I.V injection.
+*'''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.
 ===Virus survival time outside the body===
@@ Line 85: / Line 85: @@
 * Distilled water should be avoided in large amounts directly into a vein, as it can cause your blood cells to become hypotonic, possibly leading to death.
 * Hot tap water should always be avoided because it contains heavy metals.
-* Boiled tap water: It is also important to change the water at a regular interval to prevent bacteria growth within the water. Be mindful that using multiple needles in the same water supply can easily spread illness and disease. No other liquid substance should be added to the injection, even if it is supposed to increase the solubility of the drug in the water solution. Heat can be used to aid dissolution, but fruit juice or vinegar can lead to infections.
+* Boiled tap water: It is also important to change the water at a regular interval to prevent bacteria growth within the water. Be mindful that using multiple hypodermic needles in the same water supply can easily spread illness and disease. No other liquid substance should be added to the injection, even if it is supposed to increase the solubility of the drug in the water solution. Heat can be used to aid dissolution, but fruit juice or vinegar can lead to infections.
 Water for injection can also be used for [[Nasal spray guide|nasal sprays]], and eye drops.
@@ Line 95: / Line 95: @@
 ===Sterile syringe and sterile hypodermic needle===
-[[File:Rig.png|300px|thumb|right|The full injection set up is shown above. The 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.]]
+[[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.]]
 About 0.1 mL of the solution is lost in conventional syringes through the [https://en.wikipedia.org/wiki/Luer_taper Luer taper] tip and the Luer taper adapter of the hypodermic needle. That can be compensated by either adding extra 10% or 5% substance in 1 mL or 2 mL syringes respectively, or by using [https://en.wikipedia.org/wiki/Low_dead_space_syringe low dead space syringes].<!-- Added to: Routes of administration, Safer injection guide -->
@@ Line 104: / Line 104: @@
 ====Sterile syringe with sterile intravenous hypodermic needle====
-Used for IV injection. Insulin syringes (with cemented 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.
+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 needles are very short).
+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|An IM needle differs from an IV needle in length.]]
+[[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 needle 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.
+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.
 "It is common to have muscle pain when injecting larger doses of liquid Ketamine into muscle tissue. The pain can continue for several days if it is not administered properly. The muscle soreness can be somewhat controlled by using a very fine (small gauge) needle and by injecting very slowly. It should take 15-30 or more seconds to inject a dose into a muscle. If you feel it begin to sting, slow down the injection rate."<ref>{{cite web |title=Erowid Ketamine Vault : Dosage |url=http://www.erowid.org/chemicals/ketamine/ketamine_dose.shtml#im |website=www.erowid.org}}</ref>
@@ Line 152: / Line 152: @@
 #If using the traditional crook of the elbow injection site, one may need to apply pressure above the vein to make the vein stick out more. This is typically achieved through "tying off," which refers to the practice of wrapping a solid band or tourniquet around the upper forearm so that blood constricts and the veins become more visible.
 #Take three deep breaths.
-#The 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.
+#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.
 #[https://en.wikipedia.org/wiki/Venipuncture Venipuncture]: However, for typical injection in the arm, penetrate the skin at a 15 to 35-degree angle and always inject toward the heart. Avoid to push the hypodermic needle deeply into the vein to avoid [https://en.wikipedia.org/wiki/Extravasation_(intravenous) extravasation] which can serious injury and permanent harm, such as tissue necrosis.
-#Once you have penetrated the skin, and it feels that you have punctured the vein with the 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 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 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 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 needle.
+#Once all the solutions have been injected, slowly remove the hypodermic needle.
 #Block the bleeding from the vein by gently pushing a piece of toilet paper on it for approximately 20 seconds.
 #Use a new alcohol swab to clean the injection site. There may be a little blood.
@@ Line 175: / Line 175: @@
 </center>
-*'''Needle length''' - It is important that one uses a needle that is longer than the IV needle in order to reach the muscle tissue.
+*'''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.
 {{Safer injection guide-basic procedure}}
-#To prepare the 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.
+#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 skin around where the injection will be administered. With the free hand, gently press on and pull the skin so that it is slightly tight.
-#Hold the syringe barrel tightly and use the wrist to inject the needle through the skin and into the muscle at a 90-degree angle.
+#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 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.
+#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.
 #Push down on the plunger to inject the solution. Do not push the plunger down hard and fast; some substance solutions may burn. Injecting at a slower rate reduces the pain.
-#Once the solution is injected, remove the needle at the same angle as it went in. Re-swab the area of injection with an alcohol swab.
+#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.
 ====SC injection====
 [[File:SC injection skin pinch.jpg|300px|thumb|left|Hold and pinch the skin to inject into the subcutaneous tissue.]]
-'''<span style="color:red">Warning: This method of injection is uncommon and is not advised. The 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>'''
+'''<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>'''
-*'''Needle type''' - An IV or insulin 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.
+*'''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.
 *'''Administration sites''' - The areas where SC injections can be administered in are the abdomen, the thigh, the lower back, and the upper arm.<ref>How To Give A Subcutaneous Injection (drugs.com) | https://www.drugs.com/cg/how-to-give-a-subcutaneous-injection.html/</ref> It is important to vary the injection site to avoid infections or injuries. Seek immediate medical care if a rash develops at the injection site or swelling is present after injecting.
 {{Safer injection guide-basic procedure}}
 #Hold the syringe in the dominant hand and grasp and pinch the skin where one will administer the SC injection.
-#Inject the 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.
+#Inject 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 (skin) tissue.
-#Remove the needle at the same angle that it entered and re-wipe the injection site with an alcohol wipe.
+#Remove the hypodermic needle at the same angle that it entered and re-wipe the injection site with an alcohol wipe.
 ==Cleaning up after injection==
-In order to prevent the spread of blood-borne diseases and bacterial infections, <span style="color:red"><b>clean up and dispose of used needles and syringe barrels properly</b></span>. The needle and barrel of the syringe can hold old blood, that can harbor viruses.
+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.
 ===Sterile single-use spoons===
@@ Line 205: / Line 205: @@
 ===Hypodermic needles===
-One should always re-cap their '''own''' old 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!'''
+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!'''
 After the needle has been re-capped, it should be disposed of properly. Take the used needle and syringe to a medical waste/sharps disposal facility near you. Do not simply leave the needles lying around as this makes them available for re-use by others and is a possible vector for disease. Leaving needles lying around, especially if they are uncapped, also leads to an increased risk of accidental skin pricking which can cause injury, infection, or disease.
@@ Line 220: / Line 220: @@
 You'll find sharps disposal containers in your local drug store, often offered gratis. They are also offered in needle exchange programs.
-However, if you don't have access to a sharps disposal container, please collect the syringes and needles in a puncture and leak-resistant plastic container, and leave it to your drug store as soon as possible.
+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.
 ===Biological residues===
@@ Line 244: / Line 244: @@
 Sterilizing capacity of an autoclave:
-* [[Sharing_injection_materials#Hepatitis_C|Hepatisis C virus]] (HCV): Sterilizing 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.
+* [[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.
 Sterilizing capacity of an autoclave or pressure cooker:
@@ Line 253: / Line 253: @@
 The injection of illegal drugs may lead to a higher risk of legal consequences. These consequences differ by country, state, and county. One should research the laws in their region before choosing to inject.
-*'''Needles and syringes''' - 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.
+*'''[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.
 *'''Overdoses''' - If someone overdoses, the person who stays with them and calls emergency medical services will not be prosecuted. Do not simply leave a person who has overdosed to die out of fear of legal repercussions. The legal repercussions of staying with someone that has experienced [[drug overdose]] and calling emergency medical services vary by location.