2. Vein Care & Safer Injection Tips For people who work with injection drug users Presenter: Jason Naki

3. Expectations and Hopes Provide accurate information Improve knowledge Increase comfort Create opportunity to decrease shame and stigma Encourage in-depth conversation

4. Presentation Overview What is Vein Care? How the circulatory system works Injection risks Tips for injectors to minimize damage Vein Care Assistance Questions?

5. What is Vein Care? Vein Care aims to decrease the damage one does to their veins by injecting drugs through education and counseling. Thereby reducing their chances of becoming infected with or passing on various communicable diseases.

6. “...Vein Care is not meant to be prescriptive or exhaustive about the practice of injection, merely a beginning to what is a bountiful set of options for improvement and a tool for overcoming the damage caused by silence and shame around injection.” Chicago Recovery Alliance Website: www.anypositivechange.org Disclaimer...

7. Aid in the prevention of Abscesses, Cellulitis and other skin/soft tissue infections caused by improper injection. Goals of Vein Care Counseling Give clients the knowledge and power to pass on to other injectors.

8. A strong, muscular pump (a little larger than a fist) that pumps blood continuously through the circulatory system.

9. All-in-Vein Blood Vessels Blood Vessels are soft, elastic tubes such as arteries, veins and capillaries in the cardiovascular system Veins arteries Veins are made of several thin layers of muscle tissue; they carry blood to the heart, then is pumped to the lungs so oxygen can be replenished, and sent back to the heart to be pumped into general circulation in arteries

10. Veins carry blood from various parts of the body back to the heart Arteries carry blood away from the heart. Arteries vs. Veins

11. What is a Vein Valve? Valves are flaps of tissue in veins that help bring the blood back up to the heart, by acting as a one-way door. Valves are found along the length of the vein. Injecting into a valve is the most common reason for missing a hit or collapsing a vein or not getting a “flag”

12. Abnormal Valves... “Ropy”

13. Why Should I Use a “Tie?” Using a tourniquet makes the veins on the surface get bigger, and easier to hit! Be careful not to tie the tourniquet too tight...it actually works against you because it stops the blood from getting in. Using a Tie regularly helps keep your veins flexible and in good shape, thus making less scar tissue. Exercise those veins!

14. Dilute your Dope! More Dilute = Happier Veins

15. Where Should I Inject? OK! SAFER! Arms are best- easier access = safer injection

16. Proper Technique Needle position Make sure the Bevel of the needle is up.Make sure the Bevel of the needle is up. Position the needle at a 30-45° angle (depends on how deep the vein is.)Position the needle at a 30-45° angle (depends on how deep the vein is.) Align the syringe with vein.Align the syringe with vein. Follow the natural blood flow of the vein.Follow the natural blood flow of the vein. Inserting the needle through the vein.Inserting the needle through the vein. Injecting without releasing the tourniquet or not using one at all.Injecting without releasing the tourniquet or not using one at all. Injecting in the vein against the flow of blood.Injecting in the vein against the flow of blood. Common Mistakes & Poor Injection Habits:

17. Deep Vein Thrombosis Thrombosis is the clotting of blood in an artery or vein resulting in partial or complete blockage of blood circulation in the affected area. Repeated injecting may cause inflammation of the vein which may lead to Deep Vein Thrombosis. The secondary risk of DVT is a piece of the clot breaks off (embolism) and blocks a blood vessel further along which may lead to stroke or pulmonary embolism (blood clot in the lungs.)

18. Risks of hitting a nerve? If you hit a nerve pull out and apply pressure, then seek medical attention right away! Hitting a nerve can cause permanent nerve damage which can lead to complete or partial paralysis of the affected area. You will know that you hit a nerve if you feel “electric” pain or involuntary movement (reflex).

19. Risky Injection Spots VERY RISKY!  TORSO More likely to permanently damage lymph vessels or nodes. RISKY!  NECK Injecting in the veins in your neck can cause deadly infections in the brain. Arteries and Nerves travel very close to the veins in your neck. Using the veins in your feet, legs or groin, increases your risk for Deep Vein Thrombosis (blood-clots) causing blockage to vital areas in the body, as the blood returns back to the heart.  GROIN (Femoral v.)  FEET  LEGS  CHEST

20. What if I hit an artery? If you hit an artery, pull out and put direct pressure on it for at least 20 minutes (use tape and gauze if you have it). If the bleeding does not stop, go to the Emergency Room right away.

21. Avoid Abscesses!!! Always wash your hands (and injection site if possible) with warm soapy water. Use a new syringe every time you inject. Use an alcohol pad to move the dirt and germs away from the injection site by moving it outward in a circular fashion from the center. Abscess is an infection under the skin caused by the needle pushing the bacteria through the skin. Apply firm, steady pressure after the injection. Use a band aid or tape & gauze if you have it.

22. See Jason, Vein Care Specialist EveryWednesday Vein Care Workshops at the Downtown Needle Exchange

23. QUESTIONS?