A philosophy of harm reduction promotes information and resources for injecting drug users. General guidelines on safer injecting various substances intravenously are typically based on the following steps.
The preparation area for drug preparation should be cleaned with warm soapy water to minimize the risk of bacterial infection. [1]
The equipment required involves new syringes and needles, swabs, sterile water, filter, tourniquet and a clean spoon or stericup. In order to minimise the chance for bacteria and viruses to enter the bloodstream, people are advised to soap their hands with warm water. However, as people do not always have access to hot water and soap when they are injecting, the philosophy of harm reduction seeks to find the most realistic option that people can take. Alcohol swabs are commonly distributed with injecting equipment, and while they are less effective than hand washing, their use is more effective than nothing. The sharing any of injecting equipment, even tourniquets, is highly discouraged, due to the high danger of bacteria and viruses being transmitted via the equipment.[1]
Sterile water is also recommended to prevent infection. Many needle and syringe programs distribute ampules of sterile water for this reason. Where sterile water is not obtainable, the harm reduction approach recommends tap water boiled for five minutes, and then allowed to cool.[1]
Once the water and substance are combined in the mixing vessel and mixed, heat is sometimes applied to assist the mixing. Filtering is recommended by health services, as the mix can consist of wax or other non-soluble materials which are damaging to veins. Wheel filters are the most effective filters, [2] however cotton wool or tampons can be used, although to be more effective, several filtrations should be undertaken.[1]
Once the mix is drawn into the syringe, air bubbles should be removed by flicking the barrel with the needle pointed upwards in order to prevent the air entering the blood stream.[1]
A tourniquet can be used to help people access their veins. The tourniquet should not be on too tight, or left on for too long, as this causes the veins to swell and stretch. When injecting, the needle’s 'hole' should face upward and be eased into the vein at a 45 degree angle. In order to prevent stress on the vein, the needle should be pointing towards the heart.[1]
The plunger should be pulled back a little (known as ‘jacking back’) to see if the needle is in the vein. Blood should appear in the barrel of the syringe if this is the case. This process is known as registering.[1]
The tourniquet should then be taken off and the plunger gently pushed. After injection, a clean tissue or cotton wool should be pressed against the injection site to prevent bleeding. Although many people use an alcohol swab for this purpose it is discouraged by health services as the alcohol prevents the injection site from clotting.[1]
Dispose of injecting gear using a 'sharps bin' if supplied. Other rigid-walled container such as a bottles are recommended as a second best option.
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