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Injecting in the same vein repeatedly causes damage to the vein. Thus, planning to use a variety of injection sites improves vein health. This is known as “rotating” injection sites. Classic sources of information include Chicago Recovery Alliance's Better Vein Care/Safer Injection Guide and Harm Reduction Coalition’s Getting off right: A safety manual for injection drug users. Focus on resources that center the voices of people who use drugs.
Vein: best, OK, please avoid
Best: Engage in better vein care or take a break from injection with “booty bumping,” inhalation, sniffing, or other drug administration styles
OK: Follow the hierarchy of safety of intravenous injection sites from safer to less safe: arms, hands, legs, then feet. Avoid veins that cross over joints, local infection/injury
Please Avoid: injecting into your groin or neck
Start with injection sites further from the heart and move closer to it to reduce the risk of dislodging a clot from an earlier injection site.
Vein care includes:
regularly exercising muscles, which makes accessing veins easier,
tense and then relax local muscles repeatedly to increase blood flow to the area or tap sharply over the vein to induce reflexive vasodilation
learning to identify and then injecting above or below valves
drinking a glass of water instantaneously plumps veins
warming your body up with a warm compress, shower, or exercise to bring veins to the surface
injecting bevel up with the flow of blood
choosing the veins that are safer to inject into, as in not near a vulnerable part of the body
Give veins a rest and try other ways to ingest drugs. Other drug administration styles may not achieve the same “rush” as intravenous injection but drugs will still absorb most quickly from the rectum and more quickly from nose and lungs than ingesting by mouth.
Vein love: tying off
Applying a tourniquet above the injection site increases the size of vein to improve injection accuracy, and the hole from the injection becomes smaller after removal of the tourniquet, thereby reducing wound and healing time.
The material used as a tourniquet should be easy on the skin and have elasticity
A tourniquet should be easy to remove one handed, via a slip knot.
Tourniquets pose infection risk if splashed with blood and should be sterilized if reused.
The purpose of the tourniquet is to restrict blood flow and cause the veins to bulge. A tourniquet should restrict venous return without impairing arterial circulation; to assure arterial patency check for a distal pulse. Tying the tourniquet with a slipknot above the site of injection allows a user to release the tourniquet one handed with ease. Tourniquets should be sterilized with an alcohol pad in between uses.
Vein love: best, OK, please avoid
Best: Hospital grade/harm reduction tourniquets
OK: Bike inner tube, stockings, something stretchy
Please Avoid: Hair ties, belts, neck ties, or using no tourniquet
Elastic tourniquets or stockings cause less harm to the skin than leather belts without stretch.
Hair ties are difficult to get off. Anything used as a tourniquet should be tied with a slip knot that can be easily removed.
Some found objects that work well as tourniquets include, lubricated condoms, bike inner tubes cut to size, or stockings. Socks and neckties may work in a pinch, but belts are not recommended.
Ideal length is like around a foot or 18 inches. The length should allow for the ease of tying a slipknot.