Vein Care, Look after your Veins is a pamphlet by Exchangetools.org harm reduction programming from the UK and is available online at

http://www.exchangesupplies.org/campaignmaterials/veincare/vcbooklettext01.html

Vein care booklet
The vein care booklet is packed with information on how problems are caused, and on how to preserve veins. Essential reading for all injectors. This booklet is aimed at people who inject drugs to help reduce some of the problems caused by injecting.

Improving injecting technique can really reduce vein damage and prevent some of the serious conditions that affect people with lots of collapsed veins. It can also prevent or delay the move to riskier sites.

Why?
You have only got one set of veins. If you give them a break when they have been damaged by injecting, they can sometimes recover. But once veins collapse they are gone for good.

If only a few veins have collapsed, the blood can use other nearby veins to get back to the heart, but if more and more veins collapse the arm or (more seriously) leg can become swollen, cold and painful.

This condition can be life-long and although it may get better when you stop injecting, things seldom return to normal.

The information in this booklet aims to reduce the harms of injecting by helping you to preserve the veins in your arms and give you time to think about stopping or changing the way you take drugs.

Clots and vein collapse
Blood is amazing stuff: it flows around our bodies without clotting, but as soon as we get a cut or graze it stops flowing and forms clots, which turn into scabs and then into scar tissue. It does this because there are billions of tiny cells called platelets, which clot as soon as there is any turbulence in the flow of blood.

The lining of veins is perfectly smooth, so that the blood won't clot as it flows along.

But the smooth lining of the vein can be damaged by:

the needle

the drug (especially tablets/crushed pills and harsh chemicals like speed)

injecting too often or too fast

infection

'flushing' the syringe after your hit.

When the lining of the vein is damaged clots can form, eventually leading to vein collapse.

How veins collapse:

Damage to the lining of the vein causes turbulence in the flow of blood

The turbulence causes clots to form on the inside of the vein.

These clots make the vein narrower, causing more clots to form, making the vein narrower still

Eventually the vein blocks, and the clots turn into scar tissue which shrinks and pulls the sides of the vein together, causing it to collapse..

Rotating sites
Injecting into both arms and varying the places that you inject will give your veins a chance to recover between injections.

It is always easier to inject with the hand you write with. Learning to inject with the other hand will help save your veins.

It is better to learn this skill sooner rather than later - because you don't want to start learning to inject with your other hand when you need a hit, but can't find a vein.

Needle and syringe size
Use the smallest size needle that you can - for most people, and most sites, this is the standard 27G needle that comes with a 1ml syringe. Using finer needles requires great care as they are more likely to bend and break.

Avoiding misses
Injecting some of the drug into tissues around the vein can be very painful, cause serious infections and drastically shorten the life of veins.

Hurrying to get the needle in, putting it in at the wrong angle, not checking its position carefully, and pushing the plunger down too quickly can all cause leakage and bleeding around the injection site. If you inject too quickly, the vein may not be able to take all the extra fluid, and some can escape into the tissues around the vein.

When people can't understand how they 'missed' - because they know they were in the vein - it is probably because either the needle has come out of the vein during the injection, or they have injected too fast and some has leaked out. The smaller the vein, the slower the injection has to be.

' Flushing '

Flushing = in the U.S. its called jacking or booting/filling the syringe up with blood over and over after you push your hit in.

When you flush there will be some movement of the needle -it is impossible to avoid it.

Syringes are medical devices designed to deliver the entire dose of a drug: flushing does not increase the amount of drug you inject or give a better hit, but it will shorten the life of your veins.

Infections
Injecting allows bacteria to get past the protective barrier of the skin.

When bacteria are injected directly into the bloodstream, the body is usually able to kill them (this is not the case with viruses). But when the vein is missed, the warm, moist, airless dark space under the skin is an ideal place for them to grow.

Infections and swelling around an injection site can slow the flow of blood, and lead to clotting and scarring which can collapse the vein.

To prevent infections, abscesses and vein damage it is important to always:

use new sterile equipment;

wash your hands and the injection site with soap and water;

clean your mixing equipment before (and ideally after) every injection.

If you do get an infection or swelling in your arm or hand, take off your rings as they can cut off the blood supply.

'New veins'
People sometimes find a new vein, usually near the surface, where there wasn't a visible vein before. Unfortunately these never last because they're not really new veins.

What happens is that as veins collapse and circulation gets restricted, it gets 're-routed' through smaller and smaller veins. If the pressure in a small vein gets too great, it can blow up like a balloon.

The walls of these veins are very thin and fragile. Sticking a needle in them usually results in a painful bruise. If you are at the stage of finding these 'new veins' you should seriously think about stopping injecting because carrying on is likely to lead to serious, and life-long, circulation damage.

Tourniquets
Tourniquets are not needed for a vein that you can find easily.

If you are having difficulty finding a vein, washing your arm in hot water, having a hot bath (get out before you inject!), or doing a quick bit of exercise (like press-ups, or swinging the arm) are the best ways of increasing the flow of blood and therefore the size of the vein.

If this doesn't work, putting a tourniquet on can help. Tourniquets must not be applied so tightly that they restrict the flow of blood into the arm (you should be able to feel a pulse in your arm) as this makes the veins harder to find.

It is also essential that you release the tourniquet as soon as you get a vein because if you try to inject while the tourniquet is still tight, the drug will often leak out around the needle and cause a miss.

Cocaine
Cocaine is a powerful local anesthetic. After one or two hits the whole area around the site will be numb. This means that it gets harder and harder to hit the vein -and to know when you're missing.