Intravenous and Intramuscular Injection

[Orlando]

This FAQ covers the two main types of injection – intramuscular and intravenous. For more information on injecting, read “Getting Off Right – A Safety Manual For Injection Drug Users. The GOR manual is comprehensive, detailed, accurate and illustrated.

MANDATORY VIEWING
Both of these images are taken from the Getting Off Right manual.

• Syringe Terminology
  
  
  
  
• Tying Off Diagram
  
  

For those who just want the bare bones of injecting, read on…

Why do people choose to inject?
Injection provides a more intense rush than any other method of administration. Also, the desirable effects can be achieved with smaller doses. In this sense, injection is the most economical method of delivery. Some people also say that the act of injecting can be pleasurable and somewhat addicting.

What are the risks of injecting?
For a more extensive list and more detailed explanations of the risks, read the related section in the GOR manual or check out this page ->Differential Diagnosis Of Fever In Intravenous Drug Abusers.

Here is a quick list of some problems that may result from injecting:

• Site Infection – This is an infection of the injection site. When you inject, you are creating a small wound. If there is contamination on the needle or if the site becomes contaminated after injecting, then an infection may result.
• Localized infection – This is an infection somewhere else in the body that has been caused by the contaminants introduced via injection. Localized infections can occur almost anywhere because your blood goes almost everywhere.
• Disease – Disease can result from a pathogen entering the bloodstream along with the drugs.
• Damaged blood vessels - The interior walls of blood vessels are normally totally smooth. If there are any particulate contaminants in the bloodstream, these contaminants can scratch and damage the interior walls of blood vessels. The walls of the blood vessel can also be damaged when inserting and withdrawing the needle.
• Collapsed blood vessels - Collapsed blood vessels are those in which the interior wall has become scarred and heals to itself, blocking the flow of blood.
• Other tissue damage – This could be muscle tissue that is damaged by injecting particulate contaminants along with the drugs when delivering an IM injection.
• Arterial hits – Accidentally hitting an artery instead of the intended target. This may result in an arterial tear or rupture. This can also result in loss of a limb or life (seriously).
• Visible track marks or abscesses from improper technique or poor hits.

What can I do to make injecting safer?

• NEVER SHARE GEAR. This includes needles, spoons, saline solution, everything. Never, ever, ever let anyone else use your gear; and never borrow from someone else. If someone else draws saline solution from your supply with their needle, your “sterile solution” may not be exactly sterile anymore.
• NEVER REUSE NEEDLES. They will have dulled; and cannot be properly cleaned.
• ROTATE INJECTION SITES. Do not repeatedly inject in the same spot. Give each site time to heal.
• CLEAN ALL OF YOUR GEAR BEFORE AND AFTER EVERY INJECTION. You do not want to put away dirty gear – this will promote the spread of disease, and may contaminate the container in which you are storing it.
• DO NOT SHARE YOUR GEAR! Seriously, don’t do it.

What supplies does one need to inject?

Gather the following items:
A. Paper towels and rubbing alcohol or sterile alcohol wipes.
B. Syringes – Be picky and buy B&D brand syringes. Buy the 1cc long needle versions - 29gauge for IV; 25-27gauge for IM.

If your dose is not coming from a medically sound container (prepackaged ampoule, etc), you will also need:
C. Q-tips, cotton balls, or something else that can be used as a sterile filter. Do not use a cigarette filter. If you use a cotton ball, do this: tear off a small bit of cotton and roll it into a small, tight ball. This must be small – about the size of a BB, ~2mm in diameter – and TIGHT.
D. Sterile saline solution – Make certain it meets USP specs; there will be a small “USP” label on the bottle.
E. Metal spoon – Any spoon with a large and deep “spoon” portion will work well.
F. Heat source – Such as a lighter.

If you intend to perform an intravenous injection, you will also need:
G. Elastic band – Something along the lines of surgical tubing.



How does one go about self-administering an injection?
The following section is true for both intramuscular and intravenous administration.

First, lay out your gear. Using a layout with which you are comfortable, arrange your gear on a clean, flat and stable surface. If you need to, lay out a clean towel or some paper towels to make a clean surface.

Prepare your dose.
If the dose is coming from a medically sound container, do the following:

1. Remove the plunger cap.
2. Remove the needle cap.
3. Draw up the desired dose.
4. Replace the needle cap.

If the dose is coming from a supply of street drugs, do the following:

1. Clean the spoon. Note – there is a difference between cleaning it and sterilizing it. DO NOT use a flame to clean the spoon; just use soap and water.
2. Place a measured dose of drugs in the metal spoon.
3. Remove the plunger cap.
4. Remove the needle cap.
5. Draw up 50 units of saline solution.
6. Discharge the saline solution into the spoon.
7. Recap the needle.
8. Add heat to the underside of the spoon. Stir this solution with the plunger of the syringe. If the solution begins to bubble, immediately remove the heat.
   ---> For cocaine or other substances that are completely water soluble, do not add heat.
9. Drop your filter into the solution.
10. Uncap the needle.
11. Place the bevel of the needle on the filter and draw up the solution through the filter.
12. Recap the needle.

At this point, we diverge. The instructions that follow are for intramuscular injections. Scroll down for instructions regarding intravenous injections.

Intramuscular:

Site
For a beginner self administration, the frontal-outboard side of your thigh is a good site. Administer the injection in an imaginary box (you may want to actually draw the box on you leg if it makes you more comfortable). You are basically aiming for your vastus lateralis. Here’s how to find the site:

• The top of the box should be one hands length from you hip while sitting.
• The bottom of the box should be one hands width from your knee.
• The inboard side of the box should bisect your thigh as seen from the top.
• The outboard side of the box should bisect your thigh as seen from the side.

This site will accommodate doses of up to 5ml.

Clean the injection site.
Do this with either paper towels with rubbing alcohol, or sterile alcohol swabs. Start at the injection site, and make an outwardly-spiraling motion with the cleaning swab. Do not retrace your path.

Injecting
The injection is best given sitting or reclining.

1. Relax the muscle into which you are injecting.
2. Holding the barrel of the syringe, quickly insert the needle at an angle perpendicular to your skin. Do this in a dart-like fashion.
3. Gently pull back on the plunger. If blood enters the syringe, remove the needle and start again with a new needle.
4. Slowly push on the plunger, injecting at a rate of about 10 units per second.
5. When the syringe is empty, remove the needle from your leg.

Notes
If blood enters the syringe when pulling back on the plunger then immediately remove the needle. You have probably hit a vein and should not continue with the injection.

If you feel a burning pain while injecting, slow the rate of the injection.

Intramuscular Injection Related Links

IM site with process
PDF with some great graphics

Thanks to Flexistentialist for some of those links

 

[Orlando]

Intravenous:

Site
The veins in your forearms are the safest places to inject; followed by those in your hand, then legs and feet. Frankly, if you are injecting at a site other than your arms, you probably have a very serious problem.

Clean the injection site.
Do this with either paper towels with rubbing alcohol, or sterile alcohol swabs. Start at the injection site, and make an outwardly-spiraling motion with the cleaning swab. Do not retrace your path.

Register

1. Holding the barrel of the syringe and with the bevel facing up, gently insert the needle at an angle that is almost parallel to your flesh (15-30 degrees). Insert the needle so that it is oriented with the flow of blood. This means that when injecting into your forearm, the needle should be pointing towards your elbow.
2. When you think you are in, gently pull back on the plunger. If a crimson cloud of blood enters the syringe, you’re ready to inject.
3. If you are able to, remove your tourniquet.
4. If you are not in, keep digging - but do so gently.
5. If at any point you remove the needle, start over using a new syringe.

Inject

1. Untie the tourniquet.
2. Push the plunger all the way down, injecting at a rate of 10-20 units per second.
3. Remove the needle from your arm.

After-care

• Recap the needle and discard it in a rigid container (beer/soda can, bottle, jug, etc)
• Clean all of your gear.
• Applying Vitamin E lotion or a similar cream may help reduce tenderness and prevent marks.

For additional information see the following link:

http://www.saferinjecting.info/vcbrieftext.html#abscesses

 

[phr]

Getting off right link doesn't work anymore. Here are links to pdfs, some of which are by the same groups that put out the Getting off right manual.

http://www.anypositivechange.org/res.html

http://www.harmreduction.org/article.php?id=212

 

[barry351]

In " some of the problems that may result from injecting " I have unfortunatly experienced all 8 . I have a scar from palm to bicep, before the doctor put me out for the operation I had to sign a paper allowing him to take my arm to save my life , my arm was saved but not undamaged. Also had m.e.r.s.a. from shooting into my femoral vein,thats vein not artery, you gotta be so carefull when injecting in the femoral area,upon getting M.E.R.S.A. that caused me 3 weeks in hospital and 8 weeks in a nursing home on I-V antibiotics, before cutting my femoral area the doctor gave me a 50-50 chance of survival. follow the instructions for safe injecting and this may not happen to you !

 

[myfriendemo]

thanks for sharing. sorry you had to go through the things you did, but at least someone can say "wow that sucks, i will be more careful"