Injecting in the Hands – (and arms) and Tips for Taking Care
We massively updated this section (Dec 2015) and I hope we have provided a really useful place from where to get a grip on this delicate process.
REMEMBER; Black Poppy DOES NOT advocate the hands or fingers as a reasonable place for regularly injecting but we recognise it is the most common site for people to use after the forearm. If you must, then learn to do what is a delicate and potentially dangerous thing, as safely as possible. There are 3 main things to keep in mind that are of uppermost importance when injecting in the hand area.
NOTE: Click here for our new section on images and videos showing details on the veins of the body above the wasit -with some great 3 dimensional videos , to show the safest way of locating and accessing veins.
Your Main 3 Considerations:
1) Hygiene: Sterile equipment (or your own clean equipment at least) – and hand washing. A lot of germs sit in between fingers and on our palms, thumbs and under nails. Washing your hands well before a hit is critical here because an abscesses that forms in the hand area can quickly become more dangerous than in other areas of the body, due to the lack of skin area here able to deal with added infectious liquids etc. Nerve damage can result, or even amputation of a finger. So always wash hands before and after, if you are a hand injector (see tips below).
2) ROTATION of sites is the key to longer lasting veins, so try not to overdo one place, just because it might be the quickest point of access for a while, tempting as it is to go to the easiest place. Ideally, if you use your hand, try and avoid them next time to let them heal -or at least use the other hand. Thy get sore quickly from overuse, so ROTATE, ROTATE, ROTATE -change hands, change sites, change limbs!
3) Needle size is the 3rd main point. Always, always and only -use a 1ml (or 0.5ml) insulin syringe in the hand area. The needle must be as fine and thin as possible, and boy, does it make a difference to how long your veins last when you use the smallest needle for the job. To buy needles and syringes in the right sizes from a great harm reductionist / user friendly company, click here.
OK, so there are many who’ve been shooting up in the hands, fingers and wrist for quite a while – after all, it is the place many of us go when our arms have finally given up. While all the literature tells us ”just say no’ – the reality is that many injectors said yes to using their hands long ago. If you do shoot here, there are a few more important areas to remember.
Your hands are full of extremely shallow and delicate veins and arteries that are inside every finger and thumb as well as the hand and wrist and a massive collection of nerves that could cause severe problems for you if damaged.
Scarring on the hand area appears to be more likely for women than men but injecting here is still a very risky and often very painful business yet one that is almost as common as a using site as the forearm. So, lets go through the stages, bit by bit and examine best practice around hand injecting. It can be done safely, and is probably okay if only done occaisionally – they do it in hospital all the time -(obviously not with street powders..) so learn as much as you can to do as best as you can -and always pass on good info to your pals. Like we do!
Preparation Issues -Before your Injection:
Hydration: We rarely talk about this but drink – drink as much water and is comfortable and a bit more maybe. It really helps vein care and actually hitting a vein if you are properly hydrated -and not dehydrated from drinking alcohol all night, using to much coke etc. If you have -use your head and hydrate -you will find your vein easier.
Never leave rings or slim fitting brace lets/bangles on while injecting in this area. If a ring is left on and you accidentally hit an artery your hand and inject into it, it will swell up rapidly and you may be unable to get your jewelry off in time –especially rings. Your ring or bracelet can then stop blood flow at a time when you desperately need to get blood to the capillaries. This can cause tissue to ‘die’ – basically what we know as gangrene. Just missing your gear will cause your hand/finger etc to swell, and a ring or bangle that obstructs any blood flow can still cause gangrene if you can’t get it off, or it takes too long to get off. So take your jewelry OFF if you must do your shooting in the hands -better not to wear any at all so you don’t forget to remove it. It only takes a minute and if you’ve ever seen how fast someone’s hand can swell after hitting an artery, you’ll understand why it’s a lot safer to ditch the rings full stop.
Then -wash your hands thoroughly in WARM water -be mindful of slimy (germy!!) soap -avoid it -and wash especially inbetween the fingers. Air /shake dry. Use alcohol swabs if hands are dirty or you have no water (see more on swabs in tips below).
If you have trouble getting a vein up -and if you are reading this, chances are you do, in order to make palpating /finding the veins easier – place a heat pack or hot washcloth over the area. It causes vasodilation as blood attempts to cool itself by pooling to the surface in your veins and hence makes palpating and injecting easier.
Locating a Vein: A Nurses View
Watch this really helpful video below (8mins) from a nurse about how to find the best veins in the arm and hand, the ones they use in hospital and why, how to avoid a rolling vein, and other useful advice.
Always use a spike that is thinner in diameter (gauge) than the vein you are using.
As mentioned, for women and men this really means sticking with a one ml (1ml) or half ml (0.5ml) insulin syringe for all hand veins.
Inject much more SLOWLY in the hand area than you would for the arm and check out a venous chart to get to know your hands well from the inside. Be gentle, go slowly, never over knuckles, and never go too deep or you could hit an artery. Keep your syringe at approx 10 -30 degree angle (for hands) and don’t push deeply downwards! Use your fingertips to FEEL the vein, that can be as or more important than actually trying to see it.
Choosing/readying your site:
(Thanks to Nichilthegrizzlybear.blogspot.co.uk for a large part of the following tips -its slightly medical language, but we have edited and tried to make it more user relevant)
- TAKE YOUR TIME.
2. When looking for veins, always try and rely on your sense of touch first. Seeing veins is always a good hint of where to go, but a vein should feel soft and spring back – even more so when the tourniquet is placed above it and other preparation measures are applied – and often sight can be deceptive as less suitable, superficial veins will seem more appealing.
3. For regular venipuncture, the cubital fossa is often a good place to look first (see vein pics). Care must be taken not to inject the brachial artery, but the veins are often large and always closer to the surface. However, sturdier and/or more promising sites are the forearm, the dorsum of the hand and a vein on the radial border of the distal part of the forearm (although the wrist veins are usually small, painful and restrict movement). The cubital fossa is more susceptible to kinks but it is ok for injecting into.
4. There are deceptive muscles and tendons in your hands that will feel like veins. So get the patient to flex a few times if you’re trying to differentiate between a vein and muscle.
5. Forked veins seem to roll less but remember – they often have valves by the forked area. So instead of going in, go slightly proximal to it (in order to avoid valve yet still get a vein that is less likely to roll).
6. Place the tourniquet about 20cm proximal to a promising site. Too far will not ensure enough pooling and too close may just constrict your entry point. It is generally considered safe to have a tourniquet on for five minutes maximum before ischemia becomes an issue – though I wouldn’t risk getting too close to that time, and wouldn’t tighten it too much. Remember you need to stop the vein blood flowing back up the arm -so it stays in the limb area -but it MUST NOT be so tight that you stop the arterial blood flowing to the limb. In other words -the blood needs to go out -but not back. Too tight -and it is stopped flowing -and the veins will disappear even though your hand is swollen.
7. Look for already straight veins. Pulling the vein straight won’t do anything when choosing a sight or when injecting, as it will revert to its original position.
8. Vein Valves can be tricky: All the veins in your body have valves. You can find the valves by running your finger slowly along a vein. A valve allows blood to flow in one direction only. When shooting up, if you locate the valve, inject either above it or below it, never into it. However, they are feel-able as small dips as you pass along a vein. Avoid hitting these at all costs as they are very hard to navigate out of and injecting may damage them.
9. Tap the vein gently in order to vasodilate the veins. Doing so will cause slight stress in the vein to release NO which is a vasodilator as well as histamine from mast cells which have the same effect. Rubbing gently has a similar effect and is actually more effective on cubital fossa veins.
10. When sterilising the skin with alco-wipes, allow at least 30 seconds for it to air dry. Not only will it allow more bacteria to be properly dealt with, it’ll mean the stuff won’t sting if it gets pushed into the vein. Fanning or blowing it will only increase chances of infection and cause the alcohol pool up in areas, potentially increasing the stinging as you inject.
Going In and Getting it Right:
You’ve picked your spot and have it fully prepared. You are comfortable, and your hand is balanced safely. Now all you’ve gotta do is get in there.
11. To stop vein from rolling away, pull the skin and muscles a few centimetres from the vein taut. Do not attempt to straighten the vein overtly, as, as I’ve mentioned before, it will retract to its usual state as you inject anyway, causing tissuing and more pain.
12. As you inject, the best angle, in my experience (and that of the best jabbers I’ve talked to) is anywhere between 10 and 30 degrees. Also, a quick jab as you pass through the skin is most effective in reducing pain – although taking it slow after you hit the vein wall is essential. You don’t want to jab through the other side. It is critical to make sure your syringe is NEW -sterile, sharp and yours!
Don’t forget to point the bevel up towards you!
13. If you do not see the flash of blood, do not immediately remove the needle. Attempt to withdraw the needle a few millimetres in case you went to deep. The needle may be resting on the opposite vein wall, so doing this will ensure quicker blood flow into the needle during the injection in particular.
14. Palpate, or press your fingertip around the needle to see where the vein is and where you should go if you need to adjust it further. Though painful, in our experience (and injectors will know this), “digging around” for the vein after you’ve missed is less torturous than having the needle reinserted elsewhere -but in the hands -never dig deep and be gentle. If you are using a 1ml -in the back of the hand -it will help you avoid doing this as the spike is so short. If you must go again -make sure your syringe is sharp -new preferably. It makes a world of difference to a good outcome. Stock up from your local service.
15. If you do happen to miss, remove the needle as usual and immediately press down with tissue (not swab) to prevent blood seeping into tissue. Alcohol swabs are for before injections -not after -the alcohol slows the clotting process, making the site heal slower. (see our updated abscess page).
16. If you have missed, try the other hand, or choose a spot that is proximal to the elbow on the arm as it will not be impacted by the miss further down on the vein as severely.
TAKE THE TOURNIQUET OFF AS SOON AS BLOOD IS DRAWN and you start pushing your liquid in! Enjoy!
Fingers and the End of the Injecting Road
There is more than one artery in every finger. There are also a lot of nerves too. We have known people to do permanent damage to their hands from hitting nerves, especially when using a larger spike, so best keep it to a 1ml insulin sized needle.
We are regularly warned to avoid fingers, and when you see the pic above and the small area for arteries and nerves sitting next to our finger veins (see below), you can see why. As the BP crew are ex and current users just like you, we know that when times are tough, we use fingers, thumbs, palms and hands, and that’s just being honest. But, you can really see how careful you have to be -why it is sooo important to be clean, steady, have the smallest spike and syringe, use your tourniquet properly -and rotate injection sites regularly.
Avoid fingers -there’s no doubt its dangerous territory -if things have got that bad re finding a vein -consider the French -and stick it up yer bum! Suppositories are extremely popular in many parts of the world -as the next quickest acting way to administer a drug bar smoking. You can even get a slow rush -ok it is slow but it is a rush -if you put it in the right place in the anus -approx 1 inch up (squeeze it in or lie on side ) And don’t forget friends – put it in another syringe -without the spike!
Up Yer Bum –links Good info on how to do it with your drugs -this is especially good if you have blood clots in your syringe
Creams and Hand Care
Long term injecting in the hands leaves circulation to the hands hampered and you can suffer terribly from cold hands. Keep them warm, moisturised with a good hand cream and if you can, use a cream for healing scars. There is a really excellent one called Huirodoid which is specifically for injecting/thrombosis and brusing issues, healing the vein area itself from the inside first and we can honestly vouch for it working really effectively -as well as being great for varicose veins!. Calendula and arnica are also a terrific natural creams that also work well, for healing scars and bruised or inflamed sites. There are also special camouflage creams that (mostly) are prescribed by doctors, and are fantastic to help cover track marks; it’s all about getting the right tone in your camouflage cream, and needs to be chosen correctly to cover where it is either red or blue discolouration (for example) that you are trying to hide.
Needle Length and Thickness
It really is worth finding out more about the huge variety of length and width of needles – especially regarding the gauges -the thickness/width. The gauges used for injecting range from 30G (the finest and most flexible -like the Nevershare 1ml) going backwards to 21G (the thickest and least flexible commonly used gauge). The different gauges are allocated a colour so that people can tell the difference more easily.
The needle gauge colour code works as follows:
* yellow – 30g (thinnest)
* grey – 27g
* brown – 26g
* orange – 25g
* blue – 23g
* black – 22g
* green – 21g (thickest).
To read more about this, and find out what syringes are best for the job you need, click here to Exchange Supplies’s website. You can order syringes discreetly by the large box, and learn what’s what to encourage your local needle exchange to buy in what you and your mates need.
Remember readers’: BE VERY CAREFUL WHAT YOU CHOOSE TO INJECT HERE…IF YOU DAMAGE YOUR HANDS NERVES, OR THEY GET INFECTED BY A SERIOUS ABSCESS, OR GET INFECTED BY OTHER BACTERIUM, YOU COULD BE IN BIG TROUBLE AND DAMAGE YOUR HANDS FOREVER. gO SLOW, BE CAREFUL AND BE FUSSY ABOUT HYGIENE, NEEDLE SIZES, AND WHAT YOU INJECT. AVOID CRUSHED TABLETS ANYWAY BUT ESPECIALLY IN THE HANDS -THAT, FRIENDS, IS JUST BEGGING FOR TROUBLE…