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    Injection; IV Complications and Info MEGATHREAD & FAQ III Vs I Want Blood 
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    So we've decided to comprise a thread dedicated to Injecting, more specifically people who have had something go wrong and want some information and ask questions. Also included is some information about the injection process and complications that can arise as well as an array of other information to be added.

    Intro to Injecting

    Injecting drugs into the body gives a 100% Bio-availability, being the most efficient way of introducing and getting high from a drug. Though via the IV route the filtering and delaying mechanisms that protect us when otherwise absorbed via the gastro-intestinal tract, lungs or skin etc are bypassed.
    It’s believed that injecting is associated with increased levels of drug dependence and increased risk to health form . A few examples
    • blood-borne viruses;
    • bacterial infections;
    • fungal infections;
    • damage to the circulatory system; and
    • increased likelihood of overdose.
    • Abscesses
    • Loss of limbs
    • Scarring
    • Loss of veins



    Correct IV technique

    Irreversible damage is likely to occur when there is
    repeated use of the same injecting site;
    poor technique;
    injection with blunt needles;
    injection with needles that are too large; and
    injection of irritant substances.
    poor hygeine involved



    Some instructions to follow while shooting up

    • washing hands, and cleaning the injection site with soap and water, or an alcohol swab;
    • preparing drugs for personal use in your own space, and using equipment that has not been used by anyone else;
    • choosing the smallest possible bore and length needle for the site;
    • selecting a suitable vein, and introducing the needle by carefully sliding it under the skin, at a shallow angle and with the bevel up, and then into the vein;
    • injecting with the blood flow, i.e. towards the heart;
    • pulling back the plunger to identify that the needle is in a vein - a small amount of dark red venous blood should trickle into the syringe. If a tourniquet is used it should be loosened once you have drawn blood back into the syringe;
    • injecting slowly to reduce the likelihood of drugs leaking around the needle into the tissues surrounding the vein and damaging the vein;
    • injecting the hit in two halves with a short break (a few seconds) between will reduce the overdose risk;
    • not jacking back blood and ‘flushing’ after a shot - as this can significantly increase damage to the vein;
    • removing the needle slowly and carefully;
    • applying pressure to the site with a blood proof pad, cotton wool or tissue (bruising is caused by bleeding into the surrounding tissue. Immediate firm pressure will limit the amount of bruising caused); and
    • safely disposing of used injecting equipment, and whatever has been used to stop bleeding.







    Differences between arteries and vein
    s
    General differences between arteries and veins have been summarised below (adapted from Aldridge & Cranfield 1993).


    Arteries
    • carry blood away from the heart;
    • carry oxygen-rich blood
    • (except between the right side of the heart and the lungs);
    • hold bright red blood;
    • blood at high pressure;
    • bleed profusely - spurt blood;
    • served by many nerves;
    • thick walls;
    • very elastic/muscular;
    • no valves;
    • less numerous;
    • recognisable pulse; and
    • mostly deep.



    Veins
    • carry blood towards the heart;
    • carry oxygen-depleted blood
    • (except between the lungs and the left side of the heart);
    • hold dark red blood;
    • blood at low pressure;
    • do not bleed profusely - ooze blood;
    • served by few nerves;
    • thin walls;
    • not elastic/muscular;
    • valves;
    • more numerous;
    • no pulse; and
    • deep and superficial.



    Consequences of blocking arteries and veins

    There is only one arterial route to each area of tissue in our bodies. If an artery is blocked for any length of time, all the tissue it supplies die.
    Venous blood return tends to be more adaptable: veins form a complex network with many junctions. If a vein becomes blocked, blood can find its way through a smaller vessel further back down the system. It is when these smaller vessels become overloaded with blood that swelling occurs in the hands or feet.


    Collateral circulation

    When a vein becomes thrombosed or obstructed, blood can no longer flow through it to return to the heart. The blood will therefore take an alternative route, using other smaller blood vessels to get around the blockage.
    This diversionary circulatory route is called ‘collateral circulation.’
    When most of the veins have become obstructed, this process may result in the appearance of ‘new’ superficial veins on or near the skin surface. Injectors should be discouraged from attempting to use these veins, as they are likely to be small veins that have become engorged by the necessity for them to carry more blood.

    They will therefore be under greater pressure than normal, so that injecting into them carries a greater risk of damage to the vein. The usual consequence of injecting into such veins is that within a few injections the vein becomes damaged and is no longer viable.
    If the remaining veins are also damaged, then the return of venous blood from the affected limb is likely to be even more severely restricted. This will lead to slower blood flow out of the arm and lead to the limb becoming swollen and blue. The consequences of this are discussed below under ‘Long term consequences of substantial vein damage.’


    Arterial injection

    All drug injectors should be warned that they should never inject into a blood vessel in which they can feel a pulse.

    Although most arterial injections are accidental, occasionally people attempt arterial injection deliberately. The practice of deliberate arterial injection should be strongly discouraged.
    For those who hit an artery by mistake or otherwise, advice should be to:
    • immediately withdraw the needle - do not complete the injection;
    • put strong pressure on the site for at least 15 minutes;
    • raise the affected limb if possible; and
    • seek medical advice.


    Arterial injection can sometimes cause weakening of the artery wall (pseudoaneurysm) or fungal infection of the artery wall (mycotic aneurysm). Both conditions can lead to life-threatening arterial bleeding.


    Thrombosis

    Blood clots form when there is turbulence in the flow. Damage to, or inflammation of, the lining of the vein (figure 8.1) can trigger clotting of the blood at the site of the damage (figure 8.2).
    These clots stick to the lining of the vein, and are known as thromboses. The clots themselves cause turbulence and this, in turn, can cause further clotting (figure 8.3).
    A blood clot inside a vein does the same things as a blood clot on the surface - it hardens and turns to scar tissue that shrinks and pulls the edges together (figure 8.4).


    It is this pulling together of the edges that makes veins ‘collapse.’
    Veins that have collapsed in this way do not ‘unblock’ - the blood has to find another way back to the heart.


    Vein blockage and collapse

    Veins may become temporarily blocked if the internal lining of the vein swells in response to repeated injury or irritation. This may be caused by the needle, by the substance injected, or both. Once the swelling subsides the circulation will often become re-established.

    Smaller veins may block as a consequence of too much suction being used when pulling back against the plunger of the syringe to check that the needle is in the vein. This will pull the sides of the vein together and (especially if they are inflamed) the sides of the vein may stick together, causing the vein to block. Removing the needle too quickly after injecting can have a similar effect.
    Permanent vein collapse (Figure occurs as a consequence of:
    • long-term injecting;
    • repeated injections, especially with blunt needles;
    • poor injecting technique; and
    • injecting of substances which irritate the veins.



    Long-term consequences of substantial vein damage

    When the flow of blood through the limbs has been severely affected, there are a number of problems that can arise. These include:
    • ulcers;
    • local infection; and
    • gangrene
    .


    Ulcers

    One possible result of serious deterioration of circulation can be painful areas of broken skin known as ulcers.
    Ulcers form when the skin is knocked or scratched (or injected into) and the surface is broken. The slow flow of blood means that the cells cannot reproduce quickly enough to heal the wound. The resulting moist and painful wound can take years to heal, and can be compounded by infection.

    Factors affecting healing

    * diet and nutrition;
    * stress;
    * poor accommodation; and
    * drug and alcohol use.


    Treatment of ulcers
    Unless a NSP is specifically set up to provide primary health care to clients, the client should be referred to either their general practitioner or an A&E department for assessment and treatment.

    Ulcers take many months to heal and may require frequent attendance for treatment. There are strong arguments for advocating that these and other health care needs will best be met within drug treatment and NSP services, because:
    • users of drug treatment agencies may not attend if referred to other agencies;
    • drug users may tend to believe health problems are to be expected and therefore do little about them; and
    • they are less likely to receive discriminatory treatment.



    Local infections

    As well as risks of systemic infections such as hepatitis and HIV, injecting carries the risk of introducing bacterial and fungal infections to the tissue surrounding the injection site.

    Often local infections are caused by bacteria which live harmlessly on the skin being picked up by the needle and forced below the skin where they multiply.

    The risks of local infection will be increased by:

    • sharing of needles and syringes, and injecting paraphernalia;
    • reuse of unsterile injecting equipment (including filters);
    • the use of non-pharmaceutical medication;
    • unhygienic preparation of drugs; and
    • poor personal hygiene.


    Providing injectors with an understanding of the ways in which infection may be introduced is crucial. Ideally, they should be aware of the risks they may be exposed to and how to reduce them.


    Local infections include abscesses, phlebitis, and cellulitis.



    Abscesses

    An infected abscess is a localised collection of pus that is encapsulated within inflamed tissue (Figure 9). It can be caused by a wide range of bacterial and fungal infections. An abscess is different from cellulitis in that it has a defined edge and shape.


    An abscess is characterised by:

    * raised skin surface;
    * localised heat;
    * tenderness and pain;
    * redness of the skin (in white people);
    * pus formation; and
    * a foul smell if it has begun to discharge.

    People with abscesses should be referred for medical advice and treatment. The abscess will require antibiotic treatment and/or lancing to release the pus.

    Injectors should be told never to try to lance or puncture abscesses themselves. This can spread infection and without appropriate antibiotic cover they can quickly develop septicaemia (blood poisoning). They should be encouraged to alternate injecting sites as this will lessen the risk of localised inflammation, infection and abscess formation.


    Phlebitis
    Phlebitis is irritation of the smooth inner lining of a vein (tunica intima). The roughening of the vein lining can encourage the formation of clots.

    The vein is reddened or inflamed and can sometimes be felt as a thick cord beneath the skin.

    Phlebitis can occur as a result of:

    * injecting irritant substances (such as benzos, pills, etc.);
    * poor injecting technique;
    * infection; and
    * accidental injury (i.e. knocks or blows).

    An important complication of phlebitis is deep vein thrombosis (DVT) leading to pulmonary embolism.

    If phlebitis is suspected the person should be referred for immediate medical advice. Treatment includes resting and raising the limb, antibiotics and anti-inflammatory drugs.


    Cellulitis
    Cellulitis refers to a painful spreading inflammation of the skin, which appears red and swollen with fluid (this is known as oedema).

    Cellulitis can occur as a result of:

    * irritant substances lodged in body tissues; and
    * serious infection.

    Where cellulitis is suspected the client should be referred for immediate medical advice. Treatment includes resting and raising the affected limb, and treatment with antibiotics and anti-inflammatory drugs.

    Advice for people who have had cellulitis would include the following measures to prevent reinfection:

    * using sterile injecting equipment;
    * using sterile water where available and discussing alternatives where it is not;
    * avoiding the injection of irritant or heavily adulterated drugs; and
    * removing rings prior to injecting if injecting in the hands.



    Gangrene

    Gangrene is the death of body tissue caused by impaired or absent blood supply. Gangrene can occur as a result of arterial or serious venous damage.

    The effect of gangrene can be disastrous, leading to loss of limbs. It can also cause the products of tissue breakdown to enter the bloodstream causing blood poisoning and threatening life.



    Arterial damage


    Gangrene as a result of arterial damage occurs when an artery is injected into instead of a vein. Often this is as a result of injecting irritant drugs (such as benzos, pills, etc.) into the femoral artery rather than the femoral vein. However, it can occur when people inject into the smaller arteries in the arm.

    Gangrene as a result of injecting into an artery can occur in the following ways:

    * the artery can go into spasm and interrupt the supply of oxygenated blood to the tissues;
    * the injected substance can block the artery,
    * interrupting the blood supply to the tissues; and
    * small particles of the injected substance
    * (micro-emboli) can be transported into and block the capillaries in the tissue - causing their breakdown.



    Venous damage
    Gangrene following venous damage may be slower to develop, and results when damage to the veins is such that the return of venous blood from the affected limb is no longer adequate; blood gets into the tissues at a faster rate than it can get out. In the end the reduced flow of blood through the tissues is inadequate to sustain them and they die.

    Signs and symptoms

    * pain;
    * loss of feeling and control in an area of skin;
    * swelling and dicolouration of affected limb;
    * affected extremities, i.e. fingers or toes;
    * affected tissue initially becoming white;
    * affected tissue eventually blackening; and
    * if untreated, affected tissues dropping off.



    Prevention and treatment
    Injecting drug users need to be given advice on the following subjects to enable them to prevent gangrene occurring:

    * the dangers of arterial injection;
    * the signs and symptoms of injecting into arteries;
    * first aid treatment following accidental arterial injection; and
    * discourage injection of crushed tablets and gel-tabs, especially Temazepam tablets,
    Temazepam Gelthix capsules, and Diconal.

    In the event of symptoms of gangrene occurring, injectors must be aware that:

    * this is a serious complication that will not go away unless they get medical help; and
    * they must get urgent medical treatment - if the onset is sudden they should call an ambulance.



    Other injection site problems

    ‘Missed hits’
    ‘Missed hit’ is a phrase used to describe swelling which appears around an injection site during or immediately after injection. It may be caused by fluid entering the tissue surrounding the vein because the needle has:

    * not entered the vein properly;
    * entered the vein and slipped out again;
    * entered the vein and gone through the opposite wall; and
    * entered the vein correctly but excess pressure caused the vein to split.

    These problems can be prevented by encouraging injectors to:

    * check that the needle is in a vein by gently pulling back on the plunger to see that venous blood enters the syringe;
    * always releasing the tourniquet before injecting;
    * maintain a steady hand whilst injecting;
    * smoke a small amount of heroin before injecting, when in opiate withdrawal (if possible);
    * use the smallest possible needle and syringe barrel;
    * inject at the correct angle (i.e. in line with the vein); and
    * inject the fluid slowly.

    Basic steps to take after a missed injection:

    Note: Seeing a doctor right away is always the safest route. However, if that is not an option for whatever reason, there are steps you can take yourself.

    * Apply a hot compress to the site as soon as possible. Heat causes vasodilation, (dilation of the blood vessels), thus allowing for more blood flow and faster disbursement of the drugs lingering in the tissue surrounding the vein. Massage the area gently with the hot compress for 10-20 minutes.

    * Afterwards, apply an icepack to the area for another 10-20 minutes. This will remove the remaining swelling.

    * Keep an eye on the injection site. If just a typical missed shot, the hot compress and icepack should help significantly and the swelling/redness should start to dissipate after 24 hours.

    * If after 24 hours you notice the site getting worse, you may have an infection and you should go to the doctor or ER immediately.


    A ‘missed hit’ will mean that the drug is absorbed much more slowly by the body, so that the effect will be less pronounced. It can also lead to other problems such as abscesses, cellulitis, and cutaneous foreign body granulomas.



    ‘Lumps and bumps’
    Many injectors have various ‘lumps and bumps’ under their skin, and these often cause anxiety.

    The vast majority are not serious, and are caused by the mechanisms outlined below. Checking the history of that site for causes such as:

    * previous abcesses;
    * frequently used veins that have now collapsed;
    * previous misses; and
    * history of tablet injecting

    will give strong indicators of the cause.

    However, clients should be advised that if they are worried, or if the lump/bump ever changes (size, colour, mobility) they should seek medical advice.



    Scar tissue
    The scar tissue filling collapsed veins can remain visible, and feel like there is a ‘bit of string’ under the skin, for many years. Sometimes, there can be hard ‘knots’ under the surface of the skin, at the points where there were valves.

    As with scar tissue from injuries we suffered as children that persists into adulthood, so scar tissue below the skin surface caused by injecting injuries can remain as a lifelong reminder.

    Old abscesses can also leave lumps of scar tissue that remain for many years. When clients mention a lump under their skin the first question to ask is ‘have you ever had an abcess at that site?’

    Very often the answer will be yes, and you can reassure them that the probable cause is scar tissue that filled the infected capsule when the abscess healed.


    BLUNT/REUSED NEEDLES PICTURE







    Sterile abscess
    A sterile abscess occurs as a result of injecting irritant substances such as crushed tablets and possibly as a consequence of a ‘missed hit.’

    It will often disperse without treatment but, over time, a granuloma may form around it.



    Cutaneous foreign body granuloma
    Granulomas are benign growths of scar tissue that are associated primarily with subcutaneous injecting or ‘missed hits,’ where the solution has by accident or design ended up in the surrounding tissue. In such cases a residue may stay for many years, eventually leading to granuloma formation.

    Many of the common cutting agents for injectable drugs, such as quinine, mannitol, dextrose and lactose, are not thought to cause foreign body granulomas. However the injection of crushed tablets will increase the risk. The principle filler of the tablet is often hydrogenous magnesium silicate, frequently referred to as ‘chalk’ by users.

    It should be noted that ‘successful’ intravenous injection of crushed tablets does not remove the risk of granuloma formation. It simply changes the place that they may be found, to the lungs.


    Injecting myths

    Strokes from air bubbles

    There is a generalised belief amongst injectors and the general population that injecting air is ‘not a good thing.’ Whilst this is true, it tends to be somewhat overstressed in terms of importance when priorities for injecting drug users are being considered. It is possible to observe some injectors taking little or no care about hygiene or cross-infection risks whilst injecting, but exhibiting infinite patience when expelling the minutest of air bubbles from a syringe.

    Compared to the size of an air bubble, it takes a gigantic volume of air to cause circulatory problems (the blood would froth in the chambers of the heart). Although it is desirable not to introduce air into the veins, even a few 1 ml syringes completely full of air would be unlikely to cause any problems.

    Carefully removing tiny air bubbles from a syringe can be seen as evidence that injectors are concerned about their health and are prepared to act to preserve it. Some injectors simply need more information about more important priorities such as hygiene.



    Having a second hit to ‘sort out’ a bad one

    Some injectors have expressed a belief that the best way to deal with a ‘dirty hit’ (an acute reaction to injection, characterised by shivering and sweating that is usually self-limiting) is to inject again.

    Whatever the cause of the reaction, repeating the procedure could at best make the experience worse, and at worst cause overdose.


    Common practices that damage veins

    Licking the needle tip

    It is not uncommon for injectors to lick the tip of the needle before injecting. While it is understandable that people would want to avoid loss of any of their drug, and on seeing a small drop run down the needle want to lick it this practice will add large numbers of bacteria to the needle, and greatly increase the risk of infections (especially fungal infections such as thrush). The dose of drug in the droplet that is ‘saved’ will be tiny, and as heroin is not effective orally it will make no discernable difference to the ‘hit.’


    Licking the injection site

    Again, this behaviour is not that uncommon and may be part of an attempt to ‘clean’ the injecting site prior to injection. This should be discouraged as it will increase the risk of infections, as discussed above.

    Injectors should be encouraged to include stopping the bleeding with a disposable pad or tissue, and both hand and injection site washing with soap and water to their post-injection routine.


    ‘Flushing’

    ‘Flushing,’ ‘booting,’ and ‘kicking’ are terms which refer to drawing blood back into the syringe after the drug solution has been injected, in an attempt to ensure that no drugs are wasted by being left in the hub of the syringe.

    As a small amount of the drug solution will be retained in the hub of the syringe (how much depends on the type of needle and syringe being used), it makes sense in terms of maximising the amount of drug getting into the body to do this.

    However, the small benefit of this must be weighed against the extra damage that will be done to the vein and the fact that this practice will ensure that the injecting equipment used is heavily contaminated with blood. This makes the transmission of blood-borne viruses much more likely if the equipment is re-used by another person.

    Some users claim that the process of booting or flushing intensifies the rush, so that they get more pleasure from injecting by doing it (and accordingly do it several times). There is no pharmacological basis for this belief, and they are likely to greatly increase the amount of local irritation caused by injecting if they flush repeatedly - thus shortening the ‘injecting life’ of the vein.


    Alternatives to injecting

    Smoking or ‘chasing’

    The smoking of commonly injected drugs clearly offers lower risks than injecting, both in terms of viral transmission and risk of overdose.

    When compared with injecting, smoking commonly injected drugs will offer:

    * no risk of viral transmission;
    * a lower risk of overdose;
    * lower health risks;
    * an alternative for those who are finding venous access difficult; and
    * an alternative route of administration whilst injection sites are allowed to rest.

    There is a potential value in using carefully thought-through campaigns promoting the smoking of commonly injected drugs.


    Snorting

    Snorting drugs is usually safer than injecting them in terms of the relative danger of transmission of blood-borne viruses. Viral transmission can occur if straws, etc. are used by two or more people.

    As with injecting, it is best for each user to have separate equipment for the snorting of drugs. Prolonged frequent snorting of drugs (especially cocaine) can lead to damage to the mucous membranes in the nose and cause, or exacerbate, sinus problems.


    Swallowing

    Of the commonly injected drugs, swallowing is most effective for amphetamines, which are often taken in this way, either by mixing the drug in a drink or by ‘bombing’ (wrapping it in a cigarette paper to reduce the unpleasant taste).

    If an injector is contemplating using a ‘risky’ substance (eg. what is left on a spoon after filtering), swallowing usually represents the safest way of getting it into the body.

    For those using benzodiazepines by injection - often as crushed tablets - taking them by mouth is by far the safer alternative and the effect, although slower to ‘come on,’ will ultimately be much the same.

    If heroin is swallowed it gets converted to morphine in the stomach and as a result it becomes roughly half the strength. This fact, coupled with the slow absorption into the blood stream, means that it is unlikely to be thought a viable alternative to sniffing or ‘shafting’ by drug users.



    Rectal administration: ‘shafting’, 'plugging', 'topshelving'

    The functions of the rectum are to store faeces and reabsorb fluid in order to prevent dehydration. It has an excellent supply of blood in order to carry out this function, and this means that any fluid introduced to the rectum is quickly absorbed.

    There may be some cultural resistance to this route of administration from injectors as this is an unusual route of drug administration, although some medications are given as suppositories which use the same absorption process.

    It can provide for very rapid uptake of the drug (almost as fast as injecting), although not everyone finds this to be the case. In some opiate users the cause of this may be constipation and absorption of the drug by faeces.

    The method is simple: the needle is removed from the syringe (essential!), then the tip of the syringe is inserted into the rectum, and the plunger depressed.

    It can be suggested as a route of last resort in the event of not being able to find anywhere to inject which is much better than just sticking the needle in anywhere and injecting into the muscle.

    It can also give injectors the ritual of drug preparation without the delay of fruitless attempts to find a vein, and slow absorption when they miss.

    This was extracted from http://www.saferinjecting.info/vcbri...0brief%20intro
    It’s a great site, visit it. More to come.
    Suggestions? Pics? Anything? Pm one of us or post a suggestion.[/quote]

    [QUOTE]
    Compartment Syndrome
    Compartment syndrome is an acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use, in which increased pressure (usually caused by inflammation) within a confined space in the body impairs blood supply. Without prompt surgical treatment, it may lead to nerve damage and muscle death.

    Symptoms
    * Pain is often reported early and almost universally. The description is usually of severe, deep, constant, and poorly localized and is sometimes described as out of proportion with the injury. The pain is aggravated by stretching the muscle group within the compartment and is not relieved by analgesia up to and including morphine

    * Paresthesia (alterated sensation e.g. "pins & needles") in the cutaneous nerves of the affected compartment is another typical sign.

    * Paralysis of the limb is usually a late finding. The compartment may feel very tense and firm as well (pressure). In some cases, some find that their feet and even legs fall asleep. This is because compartment syndrome prevents adequate blood flow to the rest of the leg.

    * Note that a lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures and pulse is only affected if the relevant artery is contained within the affected compartment.

    * Tense and swollen shiny skin


    Treatment
    Acute compartment syndrome is a medical emergency requiring immediate surgical treatment known as a fasciotomy to allow the pressure to return to normal.

    Subacute compartment syndrome, while not quite as much of an emergency, usually requires urgent surgical treatment similar to acute compartment syndrome.

    Source


    Endocarditis
    Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or prosthetic valves). Other structures which may be involved include the interventricular septum, the chordae tendinae, the mural endocardium, or even on intracardiac devices. Endocarditis is characterized by a prototypic lesion, the vegetation, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.

    There are multiple ways to classify endocarditis. The simplest classification is based on etiology: either infective or non-infective, depending on whether a microorganism is the source of the inflammation.

    Injection drug users typically experience right-side infective endocarditis.

    Endocarditis can also be classified by the side of the heart affected:

    * Patients who inject narcotics intravenously may introduce infection which will travel to the right side of the heart classically affecting the tricuspid valve, and most often caused by S. aureus.
    * In other patients without a history of intravenous exposure, endocarditis is more frequently left-sided.

    Symptoms
    Among patients who do use illicit drugs and have a fever in the emergency room, there is about a 10% to 15% prevalence of endocarditis. This estimate is not substantially changed by whether the doctor believes the patient has a trivial explanation for their fever. Weisse found that 13% of 121 patients had endocarditis. Marantz also found a prevalence of endocarditis of 13% among such patients in the emergency room with fever. Samet found a 6% incidence among 283 such patients, but after excluding patients with initially apparent major illness to explain the fever (including 11 cases of manifest endocarditis), there was a 7% prevalence of endocarditis.

    Treatment
    Treatment usually involves iv antibiotics based on the microorganism involved, and/or surgical treatment.

    Source
    2, 3, 4, 5
    Last edited by Mr.Scagnattie; 01-03-2013 at 08:30.

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    #2
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    Albion's Avatar
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    Last post from previous thread:

    Quote Originally Posted by devious_jeeves View Post
    I just finished a tricky shot in which I had to register a couple of times to the point where the barrel was filled with blood. Halfway through the needle blocked, so I removed it and squirted out what I presume to be a clot and did the rest. My question, does shooting clots present a major risk of causing a thrombus or embolism?

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    #3
    Very helpful thread, thank you.

    I no longer wish to attempt to IV coke... at least not for now.
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    #4
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    ^ Good choice. I never really even liked cocaine yet once I gave it a go IV. Change of story...
    I'd recommend against trying IV Cocaine if you enjoy cocaine. It's addictive as all hell.
    I'd never really enjoyed sniffing powder, smokin rock was ok but didn't have enough of a rush.
    Basically to hard to get a good bellringer & bangin hard is a pain in the ass.

    Went ahead & gave IV coke a try. Great rush, easy to get a ringer, much preferred.
    On the other hand I ended up sitting in a bathroom from midnight till 7AM doin shot after shot.
    If you IV cocaine & enjoy it, chances are you'll end up a pincushion. So good choice pbuilder.

    Hopefully this isn't really off-topic as it's basically just an encouragement to the above poster.
    As opposed to directly dealing with complications & such but someone avoiding IV use as a
    result of the thread seems like a good way to start the new thread.
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    #5
    Hello there, and first of all sorry, I have absolutely no doubt that this is the wrong place to post this, probably, but I very rarely used this website, it appears to have changed somewhat, and I have always struggled generally with computing the layout of forums in my head..find it a tad confusing.
    Anyhow, for the first time ever, and in the ridiculous situation of being pissed and on valium, I I'V'd, or rather I let someone else, who (I think, as I said I was out of my mind) had just used the pin before me, jab around at my arm. I seem to have two puncture marks up near my wrist which seem to be fine, but underneath my elbo, i've got a rather nasty lump, which is blue and sore and has funny little purple dots over it. the top of my arm feels..a bit like when someone punches you and you get a dead arm. Is this normal? Or have I royally fucked myself? Certainly don't intend to make a habit of injecting, I am indeed rather dissapointed in myself. funnily enough I don't feel any roughness yet..this was upwards of twenty four hours ago, and I vommited at the time, so perhaps I've got away, clean of a rattle..or whatever your coloquial for mini-withdrawal is.
    Certainly feel quite the opposite of the need to go out and bang some more filth in there..
    thoughts?
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    #6
    Quote Originally Posted by strifey View Post
    Hello there, and first of all sorry, I have absolutely no doubt that this is the wrong place to post this, probably, but I very rarely used this website, it appears to have changed somewhat, and I have always struggled generally with computing the layout of forums in my head..find it a tad confusing.
    Anyhow, for the first time ever, and in the ridiculous situation of being pissed and on valium, I I'V'd, or rather I let someone else, who (I think, as I said I was out of my mind) had just used the pin before me, jab around at my arm. I seem to have two puncture marks up near my wrist which seem to be fine, but underneath my elbo, i've got a rather nasty lump, which is blue and sore and has funny little purple dots over it. the top of my arm feels..a bit like when someone punches you and you get a dead arm. Is this normal? Or have I royally fucked myself? Certainly don't intend to make a habit of injecting, I am indeed rather dissapointed in myself. funnily enough I don't feel any roughness yet..this was upwards of twenty four hours ago, and I vommited at the time, so perhaps I've got away, clean of a rattle..or whatever your coloquial for mini-withdrawal is.
    Certainly feel quite the opposite of the need to go out and bang some more filth in there..
    thoughts?
    Ok first of all shooting in your wrist is not as good of a spot as you would think. Second when you say underneath your elbow are you talking about the place where everyone typically shoots up? If so then that sounds like an abscess there. If it really looks like that and its in that spot I'm describing then I would prob go get some medical help before it gets worse. I'm not trying to scare you(well I guess I kinda am for a good reason) but people have had to get limbs amputated for missed shots that were not properly taken care of. The pain in the top of your arm sounds like someone gave you a IM(muscle shot). I know you were really messed up on valium but if I were you I would ask someone that was there what the hell happened.

    And last of all what the hell were you shooting up in the first place?
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    #7
    I just thought it would be a wonderful way to start a brand new year.
    walk out of a nice party, full of nice people, to a flat in the middle of nowhere and do the one thing that has systematically ruined me through watching my friends destroy themselves. Pretty daft ey?
    I don't know where everybody typically shoots, cause I don't do it, and I've never watched people do it before until then, and i honestly cant remember much of what they were doing anyway.
    I thought you could only get absesses offa filthy needles and stuff? I really don't know. I'm staying with my mother currently, as I'm home form university, she lives in the middle of nowhere so it'll be about a week before i can get to a doc. hopefully it'll calm down, nurses have made bigger bruises, although, decdely not lumps..
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    #8
    Oh no, I know where you mean actually. not under my elbow where the big veins are per sey, more like rund the back of it, at an angle.

    And finaly, sorry, I am misreading things. shooting heroin
    Last edited by strifey; 03-01-2012 at 03:24.
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    #9
    soo... about 7 or 8 hours ago i shot methamphetamine for the first time (i've done this drug hundreds of times before - just never injected). everything went beautifully, i registered, and i'm 99% sure i didn't miss a thing BUT as i was sliding the needle out very slowly, right as i got almost out, it started burning like acid was eating through my arm or something! i immediately thought i missed the shot but then looking back on it, i know i couldn't have. i temporarily lost sensation in my fingers and hand and i was really freaking out. i ran warm to hot water on my arm for a good ten minutes trying to massage out the pain in case by some weird chain of events i did miss it. then i placed a warm towel on it and elevated my arm. probably a half hour or so later i took a look at it and saw that it was all red and swollen.. it looked (and felt) as if a bee had stung me only 100 times worse. i would say it looked like hives (only no bumps) or a bad rash.

    could this have been a histamine reaction? i know that people get those from banging h (although i never have). i've never experienced anything like what happened with this shot.

    my husband shot the same amount out of the same bag as me and nothing happened to him reaction wise. i'm thinking maybe there is just something in the speed that didn't agree with my body. i have continued to use it via smoking and my arm is starting to bruise along the vein line and for the most part i still can't feel anything in that one isolated area.
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    #10
    ^Uh, that sounds a bit like you injected into an artery. Was the blood bright red? The brachial artery runs right in the right in the crook of the arm before it bifurcates into the radial and ulnar arteries. You should probably go to the ER.

    The bruising is probably blood leaking out from the puncture in the artery. I can't be sure about this but seriously go to the hospital.
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    #11
    Aw, fuck.
    I don't think I did.. the injection site wasn't in the crook of my arm but now that i'm feeling around where it is I may have (2-4 inches down on my forearm from my wrist [yes I know... wrist = bad bad bad idea]). I don't know.. the blood wasn't bright red at all it was normal colored but leaning on the dark side. Shit shit shit!
    Last edited by misspharmacyashley; 19-01-2012 at 10:36.
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    #12
    Wouldn't there be purple bruising rather than light brown like I have?
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    #13
    Bluelighter
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    Quote Originally Posted by misspharmacyashley View Post
    Wouldn't there be purple bruising rather than light brown like I have?
    I tend to get bruising like that when shooting meth if it's a particularly strong shot.

    I also have experienced the burning sensation and get a red histamine type reaction following the vein, but the burning usually only lasts a few seconds.

    I believe the reaction is because meth is caustic and the shot is too highly concentrated for your body to accept it without irritation.

    Always use a minimum of 30 units for vein health and never be afraid to add a bit more to dilute it so it doesn't irritate your veins
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    #14
    Ok, I'm having kind of a weird problem.


    I have shot up a ton of cocaine the past 3 months. Like... a bunch, lol. Way too much. Although I haven't done any for almost a month now. Several veins have collapsed, etc. Typical damage associated with shooting coke. I know exactly what it feels like to 'miss' a shot - I've done it a million times, and that is not what is happening. I can get IN the vein, draw as much blood as I want, but when I press in it hurts like a motherfucker. Like, I can't push it in, it stings really badly. It's not because I'm 'missing the shot' - that doesn't hurt anything like this. I'm in the vein but it won't let me plunge anything into it.


    Is there a reason for this? And no, again, I am not missing the vein, that doesn't feel like this at all. I am in the vein, and it's like the vein won't accept the extra fluid being pushed in. It's not an easy flow. Is it because other veins have closed and the bloodflow in general is reduced, thus it doesn't have the capacity to take the extra fluid? (although, I will say that the veins above the ones I'm using are not all closed down, I am not trying to inject into a dead vein or into a clogged area). I have no idea what it is, how to remedy it, or if there is a solution to this problem.


    Any help would be appreciated.
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    #15
    I've been shooting suboxone for many years, not to get high, but just because I've never had good luck with sublingual route. I need the
    bup and it's been a life-savor for me. Recently I developed a sever phlebitis on the big vein on the back of my arm. after injection it became hard (rope like) and a bit swollen. Has this happened to anyone else injecting? Will I survive without going for an embarrassing trip to the doctors? Anyone with similar experience please let me know!! I'm really concerned as I'm hoping that over time it will shrink and go away but I don't want a life-threatening complication if it's inevitable. Has any of you lived through this experience with a large vein like the one on the back of your forearm (pencil size). Thanks guys.
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    #16
    Quote Originally Posted by SailingNorth View Post
    I've been shooting suboxone for many years, not to get high, but just because I've never had good luck with sublingual route. I need the
    bup and it's been a life-savor for me. Recently I developed a sever phlebitis on the big vein on the back of my arm. after injection it became hard (rope like) and a bit swollen. Has this happened to anyone else injecting? Will I survive without going for an embarrassing trip to the doctors? Anyone with similar experience please let me know!! I'm really concerned as I'm hoping that over time it will shrink and go away but I don't want a life-threatening complication if it's inevitable. Has any of you lived through this experience with a large vein like the one on the back of your forearm (pencil size). Thanks guys.

    Is it sensitive to the touch? How long has it been there? If it's been there for any period of time and HURTS... DEFINITELY GO TO THE DOCTOR.

    Has it gotten progressively bigger or more swollen, more colored? If any of those things has been the case, definitely definitely go see a doctor. You don't have to go see your suboxone doctor, just go see your M.D... who gives a fuck about embarrassing? Don't risk it if you feel it's gotten worse over time or hasn't gotten better.
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    #17
    Also, I have another question, do you guys bend your elbow when you inject into the crook of your arm? Or do you keep it straight out/angled down ? I have such a hard time keeping the needle in veins when I am trying to IV like straight upwards like that (with my arm fully extended down).
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    #18
    Thanks for the reply. No, it has not gotten any worse and is not sore to the touch at all. Just like feeling a hard rope underneath the skin about the size of a pencil and about 2-3 inches long. not red nor inflamed. If anything, its just stayed the same over a couple weeks. I
    would recognize signs of infection but there is none. just a hard section that turns soft once you go further down the arm towards my hand and soft just as it disappears towards my elbow.
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    #19
    Quote Originally Posted by SailingNorth View Post
    Thanks for the reply. No, it has not gotten any worse and is not sore to the touch at all. Just like feeling a hard rope underneath the skin about the size of a pencil and about 2-3 inches long. not red nor inflamed. If anything, its just stayed the same over a couple weeks. I
    would recognize signs of infection but there is none. just a hard section that turns soft once you go further down the arm towards my hand and soft just as it disappears towards my elbow.
    I have something somewhat similar. Do you use that place to IV a lot? rotate sites. You probably missed some... and I think I know what vein you're referring too, try using one higher up your forearm, that vein can get irritated (although I know it's very tempting to keep using because it's so big... I've collapsed it on both forearms )
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    #20
    Quote Originally Posted by TheMoney View Post
    I have something somewhat similar. Do you use that place to IV a lot? rotate sites. You probably missed some... and I think I know what vein you're referring too, try using one higher up your forearm, that vein can get irritated (although I know it's very tempting to keep using because it's so big... I've collapsed it on both forearms )
    Ya, this scared me and I quite shooting all together. I've had other veins collapse but none that just stayed large like this and felt like a
    little rope underneath the skiing. Hopefully it will absorb over time and get small. It's not getting any worse. Just not going away very
    quickly...
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    #21
    I think something is really wrong, but I don't know what it is exactly.

    Admittedly, after reading the IV complications guide thoroughly, I realize now that I've been doing a few things incorrectly. Like, I have been using the same injection sites for a long time. Both sites are on the same arm, about an inch away from each other(both in the crook of my right elbow). Those are the only two veins that show for me and the only ones I can ever manage to register in, so those are the ones I was using. However, I started having complications with registering on the second injection site, and so for a week or so now, I have been using the same injection site. It still registers, but it takes more work than it used to. The other thing I've been doing incorrectly is using blunt needles at times. I don't use them A TON, but I don't use a fresh needle every single time either. I don't have access to a needle exchange where I live, and I only get fresh needles maybe once every few weeks or so. I do try to use fresh needles as often as possible, but it doesn't always work out that way.

    Now, my right arm is hurting, I mean REALLY hurting. I can't straighten it out completely because the pain becomes too much. It hurts around the site I've been using, but like it's spread out if that makes sense? Also both sites are REALLY hard, and it extends a little bit up the inside of my elbow. I don't know if it's the vein there or what... the track marks on the old site are almost gone completely, and the one on the site I use now doesn't look infected or anything minus a LITTLE bit of redness, but in my experience that's normal with cuts. Or is it?

    Mostly what I'm concerned about is that about a week ago (it was when I was still using both sites) I started to get REALLY sick. I thought it was cotton fever at first, but then it hung on, so then I thought it was just a flu, but it's still hanging on and it's not behaving like any normal flu I've ever seen or had. My symptoms are: almost complete loss of appetite, getting really cold and beginning to shake extremely violently - this happens at the very least twice a day and lasts for about 15 minutes or so - even if I'm in the sun or somewhere warm, extreme lethargy and fatigue, the absolute worst migraine headaches I have ever experienced, as well as the worst neck pain I have ever experienced (the pain doesn't seem to be located in the muscle, it seems to be located on top of my spine?! At least that's where it hurts when I touch it), insomnia despite the fatigue and lethargy, slight nausea, respiratory distress (coughing, shortness of breath, etc.)... and the thing that scares me most, is that when I stand up from sitting, or even when I'm sitting and do the smallest thing that requires the tiniest amount of exertion, my heart begins beating superhard and fast, to the point where I can hear it in my ears. It's really scary.

    Oh, I forgot to mention, I also have a fever that comes off and on. It can go from 103 to 98 to 100 to 97 all in one day. This has been going on for about a week now, and there is no sign of anything getting better. It's not getting worse (minus the neck pain and cough, maybe) but it's definitely not getting better. On average, I'd say it's stayed at about the same level since it first started.

    So could these two things be related, the sickness and the issues with my arm?
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    #22
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    You should see a healthcare professional, it sounds like it could be an IV-related bloodborne pathogen.
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    #23
    Bluelight Crew effie's Avatar
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    Xbc, you really do need to get this checked out ASAP - what you are describing are the symptoms of an infection as tricomb said. If you introduce bacteria into the bloodstream they can lodge in various places (such as the heart valves in endocarditis) causing lingering symptoms such as an intermittent fever, shaking, lethargy etc. It could also be that you have developed an abscess or soft tissue infection around your arm and that is throwing off showers of bacteria into your bloodstream. The rigors (shaking) in particular is often a sign of bacteraemia (bacteria in your blood).

    You need to get this checked out as a matter of urgency, and ideally you really need to be honest with the healthcare professional about your injecting too (not only will they need to examine your arm but it is important that they are alert to the possibility of IV complicatons). Good luck
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    Random Swelling and Numbness 
    #24
    Bluelighter josie's Avatar
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    So here's whats been going on with me:

    I am a long time heroin user. I've not always used the most sterile techniques, but as of right now Im at least using a clean rig every time and such. I did china white in NOLA for a few years and had three good veins i rotated between never with any problems. Moved to Dallas, had to switch to tar. No problems for first two or three years (i have had periods of sobriety) but this last past few months i have had some VERY weird symptoms going on. Well I've blown my arm and hand veins and they are hard to hit, so if I can't hit there i usually have to use my legs or feet.

    I have been experiencing two things: periodical swelling of my feet (not due to a missed shot or anything like that, they just blow up) usually not painful but once it did hurt. This has happened about 4 times in the past 9 months. The other thing Is i am having random spots on my body that are numb for anywhere from 2-7 days, NOT at an injection site. Like, right now, the top left side of my scalp is numb and has been for a few days now. wtf? and before you ask i am way to scaed to shoot in my neck (Says the girl poking around in her legs hips and stomach). I was tested about 11 months ago full IV-drug user panel and I don't have anything (thank god, knock on wood)

    Anyway... thoughts?

    Ooh I forgot to mention, just in case y'all think this may have anything to do with it, I smoke crack probably ten days out of every month.. about $40 per day.....
    Last edited by josie; 24-05-2012 at 14:14.
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    #25
    Any tips on hiding track marks for lighter complected people?
    I'm also prone to bruising very easily, and makeup only hides so much.
    I'm tired of wearing long sleeve shirts especially now for the summer.

    Also, i'm pretty sure i missed and hit an artery a couple of hours ago.
    It was painful, and I drew light red blood instead of the usual dark red which i know is bad but i was so stressed trying to find a good vein i said "fuck it"...
    Its not too swollen but for a while i had a red rash around it, which is gone now, but it's still tender to the touch and kind of bruised.
    Should i be worried?
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