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Avoiding Arteries (Part 1)

One of the easiest ways for IV injectors to hurt themselves is by improperly injecting. This is illustrated in the following letter we recently received:

Blue glowing hand. My question [concerns] something that happened last week. I went to inject in the back of my left wrist and as I went to inject--wow--what excruciating pain! I again aspirated the syringe and blood came back. I started to push again and had to pull the syringe back out due to the pain. This was worse than any miss I've experienced. Well, immediately my left hand became discolored and swelled up until I couldn't make a fist. What happened? The swelling decreased over the next few days. No lasting problems but what a scare. That kind of pain was scary!

What the writer did was inject into an artery. This is one of hazards of IV injection. People should never inject into an artery. Since arteries carry blood from the heart to body tissue, the heroin interacts with this tissue (in concentrated form) before making its way to the heart and eventually the brain where the user wants it. Unlike an IM injection, where the heroin is put into a single location, an injection into an artery transports the heroin to a large area.

Why Arterial Injection is Painful

Injections into arteries cause pain for a number of reasons. First, heroin is an acid and (just as with an IM injection) it burns the tissue that it touches. Another reason is that arteries have far more pain receptors than do veins. Both of these kinds of pain are short-term, however. What is more important about arterial injections is that they cause a swelling of the tissue as noted in the letter above.

Distinguishing Arteries and Veins

The terrible thing about injecting into arteries is that there is no way to distinguish an artery from a vein based upon the pull-back. When the user aspirates the syringe in either case, the syringe will fill with blood.

Similarities

Most of the time, there is no problem because veins are closer to the surface of the skin. So any thing an injector sees that looks like a vein usually is a vein. But there are veins that are close to the surface, especially in places like the hands, wrists, and neck. Another thing to keep in mind is that arteries tend to run along with veins--just deeper beneath the skin. So if the injector goes too deep, he may inject into a vein.

One thing that I would really like to drive home is what would have happened if the writer of the letter above, instead of injecting into his wrist, had injected into his neck. It is very possible that his neck would have swelled up and he would not have been able to breath. This is the best reason I can think of for injectors to stay away from their necks.

Differences

Arteries are distinct from veins in the following ways:

  1. Arteries are red
  2. Arteries are smaller and less numerous
  3. Arteries "pulse"

Because of the properties of arteries, blood tends to flow more quickly through them. As a result, a pullback from an artery is usually very strong. This is often a factor in people hurting themselves; they just can't believe that they aren't in a vein because of the very strong pullback they are getting.

Testing Veins

Regardless of what an IV injector does, he should test any vein in which he is going to inject. He should release a small amount into the "vein", first. If he gets a good pullback but the injection is painful and he is still "in"--then he should withdraw the syringe and try another location.

Arteries Provide No "Rush"

If safety isn't enough to make an IV drug user stay away from arteries, he should remember this: injecting into an artery dilutes the drug and so there is no rush from injecting into an artery.

Conclusion

Whether for safety or pleasure, users should always take care to avoid arteries. Keeping in mind the ideas in this article will help. Regardless of the precautions taken, it is still possible to inject into an artery. This is a danger inherent in the IV injection procedure.

by Dr. H © 2001
Last Modified: 9 January 2004


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