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Injection Guide - Safety, Needles, Abscesses and More

Discussion in 'Anabolic Steroids & Prohormones' started by Prodiver, Jan 26, 2011.

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  1. Prodiver

    Prodiver Top Contributor

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    Injectable Steroid Containers, Syringes & Needles - Click Here for the Dedicated Thread on this Topic

    Injectable AAS come in two sorts of sterile containers: ampoules and phials (or vials).

    Ampoules

    sustanon-organon.jpg

    Ampoules are intended for single injection use: once opened the contents must be used immediately or discarded.

    Ampoules are opened by snapping off the top at the neck.

    Some ampoules have a coloured dot to show the neck's weakest point: with the dot towards you snap the top backwards.

    Ampoules without dots are best opened using an "amp snapper":

    orange.jpg

    Sometimes a bic pen top may be used.

    For stubborn ampoules score a groove all the way round the neck with a needle file before snapping.

    Swab clean all ampoules' necks with antiseptic and allow them to dry before snapping.

    Wrap the ampoule and top - not the neck - in clean tissue to protect your fingers in case they shatter.

    Do not touch or contaminate the opening. Draw up immediately.

    To draw up, hold the ampoule at an angle, insert a hypodermic needle and draw the contents into the syringe.

    Empty ampoules may be safely discarded in the normal rubbish.

    Some injectables, such as HCG, come in two ampoules as solvent and powder for reconstituting:

    hcg1500.jpg

    After opening both ampoules, draw up the solvent, inject it into the powder, swirl it gently until dissolved, draw up and inject as directed.


    Phials (or Vials)

    sale_Deca_Durabolin_200mg.jpg

    Phials are intended for multi-injection use.

    The rubber stopper is held on with a metal crimp and topped with a throw-away metal or plastic seal.

    To use, remove and discard just the metal or plastic seal but leave the crimp and stopper in place.

    Swab the rubber stopper with antiseptic and let it dry immediately before drawing up the desired dose.

    To draw up, draw the same amount of air as the desired dose into the syringe, push the hypodermic needle cleanly through the centre of the rubber stopper, inject the air, invert the phial and draw the desired dose into the syringe.

    When filling one syringe with more than one type of AAS, be careful not to cross-contaminate one phial with any AAS already in the syringe.

    When the needle is pulled out the rubber stopper will seal itself.

    AAS in multi-use phials contain non-toxic antiseptic preservatives to destroy any pathogens in the air injected during drawing up.

    Keep partially empty phials upright in a safe place.

    Empty phials may be safely discarded in the normal rubbish.


    Syringes "Barrels"

    Nowadays syringes are available with hypodermic needles already fitted, with one-use-only latches and with safety sheath systems which cover the needle as it is withdrawn.

    For intramuscular injection most AAS users find these unnecessarily complex and expensive and use widely-available conventional syringes and needles.

    For normal intramuscular injection two types of syringes are available:

    Standard, on which normal needles are a push fit:

    SYRINGE 5ML.jpg

    and Luer Lock, onto which normal needles can be locked by twisting:

    syringe 5ml luer.jpg

    Luer lock syringes are less common and slightly more expensive than the standard type, but are preferred by some as the needle will not pop off under pressure.


    Typical syringe sizes for intramuscular injection of AAS are 2, 3 and 5 ml (millilitres).

    It is easier to expel liquids like AAS through needles from smaller diameter syringes.

    Normal used syringes may be safely disposed of in the ordinary rubbish.

    For SubQ (subcutaneous) injections standard syringes and needles can be used, but usually Insulin Syringes with built-in fine gauge needles are preferred:

    insulin_syringes.jpg

    Standard U-100 insulin syringes are marked in Units, not ml.

    100 units of standard insulin = 1 ml.

    Used insulin syringes with attached needles should be disposed of in a sharps bin.


    Hypodermic Needles "Pins" "Sharps"

    Modern high-quality hypodermic needles have facet-cut chamfered points so they are extremely sharp to minimise pain.

    The least pain and trauma are caused by sliding the needle relatively slowly through the skin and muscle to the correct depth and not stabbing.

    Modern chamfered needles do not blunt quickly and can withstand two clean passes through rubber vial tops without appreciable blunting, but they are cheap enough and should be discarded if blunting is suspected.

    Modern needles are made of tempered surgical stainless steel and are very difficult to break.

    Needles are defined by gauge (thickness) and length.

    Most gauges are available in several lengths.


    Gauge

    The finer (thinner) the needle the smaller the injection wound and the less the scar tissue caused. The finer the needle the more difficult it is to push thicker, oil-based medications through.

    The bigger the gauge number the thinner the needle.

    The needle fitting which attaches to the syringe is colour-coded to denote its gauge.

    The colour code does not denote length.

    Commonly available gauges:

    Green = 21 gauge (0.813 mm)
    Blue = 23 gauge (0.711 mm)
    Orange = 25 gauge (0.508 mm)

    The thicker green needles are commonly used for drawing-up; and for injection by some experienced users.

    Blue needles are commonly used to inject; some also use them for drawing-up.

    Orange needles are mostly used for injecting: drawing up thick AAS through orange needles is difficult if not impossible.


    Length

    Green blue and orange needles are available in several lengths from 5/8 to 2 inches (~15 - 50 mm).

    It is regarded by some medics as good practice not to push a needle all the way in until the fitting touches the skin.

    Intramuscular injection is given about 1 inch into all muscles, so 1-1/4 or 1-1/2 inch needles are generally used.

    Intramuscular injection is usually perpendicular to the skin - upright; thin muscles may be injected at an angle of about 45º.

    If the injection is too shallow the AAS may leak out or disperse under the skin which affects its absorption rate.

    If the injection is too deep contact with bone or lymphatic vessels can occur which can prove painful.


    NEEDLE DISPOSAL

    09015115.png

    Used needles are a biological and physical injury hazard.

    HYPODERMIC NEEDLES AND INSULIN SYRINGES MUST NOT BE DISCARDED IN THE ORDINARY RUBBISH BUT IN A SHARPS DISPOSAL BIN FOR INCINERATION.


    Sharps disposal bins are available from needle exchanges, pharmacies and medical equipment suppliers.

    Needle exchanges will accept full bins free of charge for disposal, also some pharmacies, hospitals, walk-in centres and surgeries; other places may make a small charge.
     
  2. Prodiver

    Prodiver Top Contributor

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    Safe intramuscular injection: aspiration and sites - Click Here for the Dedicated Thread on this Topic

    Most AAS injections mean pushing several millilitres of oil excipient deep into the muscle.

    This is different from the small 0.5 or 1 ml isotonic water-based vaccines or inoculations injected into a shoulder at a GP's surgery.

    Even if isotonic water-based solutions (like saline) enter a blood vessel no harm occurs.

    But any amount of oil excipient entering a blood vessel can cause an embolism.

    A significant number of guys using AAS experience a minor embolism without recognizing what it is.

    Excipient entering the blood stream typically causes some clotting; a clot can travel to the lungs where it becomes lodged - an embolism - blocking the blood supply.

    Symptoms can come on almost immediately, or later, but usually within a minute or so - the time it takes for blood to flow from the quads, say, to the lungs.

    The symptoms are hot flushes, pins and needles, coughing, tight chest, difficulty breathing, panic, dizziness, fainting and loss of consciousness.

    Fainting carries the risk of physical injury during collapse.

    A small embolism caused by only a small amount of gear (~1 ml) may disperse quite quickly and the symptoms subside. There may or may not be any lasting damage to the lungs.

    But if the embolism is serious it may travel to the heart or brain, resulting in heart attack, stroke and consequent disability or death.

    The safeguard against an embolism is ASPIRATION: pulling back slightly on the syringe plunger once the needle is at the correct depth in the muscle and before injecting: any blood entering the syringe shows that the needle tip is in a blood vessel and that it is NOT safe to inject.

    Only a very slight, brief back-pressure on the plunger is required to clearly show any blood.

    A good technique is, once the needle is inserted to depth, to pull it back outwards just a couple of mm and then hold its top firmly with the free hand. This opens the needle tip making aspiration easy and clear, and also helps avoid pushing the needle further in and into a bloodvessel.

    Aspiration can be mastered with one hand when self-injecting, but usually requires both hands.

    Therefore the safest injection sites for self-injection are those where both hands can be used: the quads and the pecs.

    Glutes and delts, etc. are convenient for injection by others, but not easy or safe for self-injection.

    Like all muscles the glutes carry important arteries, veins and nerves at various locations and depths. You are no less likely to contact a blood vessel or nerve injecting into the glutes than into other muscles.

    In intramuscular injection the needle tunnel should always be about 1 inch into all muscles, so that no "blow-back" of the gear occurs during injection, and that it does not end up just under the skin.

    In quads and other big muscles this means inserting the needle perpendicular to the skin - upright - until the tip is an inch into the muscle.

    In the pecs and other shallower muscles it is permissible to insert the needle at an angle of about 45º so that the needle tunnel is an inch long but its tip is in the centre of the muscle belly.

    It is considered a good technique by many medics not to insert the needle all the way in to the fitting: this may have been in case of breakage, or not to push any pathogens into the wound. In any case, modern needles are extremely difficult to break.

    So because in IM injection insertion of the needle is always to about an inch, and allowing for any fat under the skin, 1-1/4 inch or longer needles are always suitable for all muscles.
     
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  3. Prodiver

    Prodiver Top Contributor

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    Safe and sterile IM injection - Click here for the Dedicated Thread on this Topic

    A good safe and sterile IM injection technique will reduce pain and the chance of infection, abscesses and embolism.

    The overriding principle for sterility is never to expose syringe fittings, needles or gear to the air for longer than absolutely necessary, where they may attract pathogens.

    The following procedure may seem long, but its logic should become second nature.

    Preparing and drawing up:

    If you like to warm your AAS in hot water or under your armpit, do so first.

    Wash your hands well.

    Collect your AAS, syringe, needles, and antiseptic and tissues, or swabs, on a clean surface in a clean room.

    A suitable, cheap and easily available antiseptic is ordinary Listerine mouthwash on tissues.

    If you are using AAS from phials, discard the seal caps if necessary and swab the rubber seals with antiseptic and let them dry.

    If necessary score or file ampoule necks for popping. Then swab all necks and let them dry but do not pop them yet.

    Meanwhile, without touching them push the syringe tip and the fitting of your drawing up needle quickly through the paper of their packages and join them immediately. Discard the packaging.

    Do not remove the needle cap until you are ready to proceed.

    For phials: without removing the needle cap, draw into the syringe the same volume of air (and sterile gas in the cap) as the amount of gear you're going to draw up.

    Remove the needle cap and push it slow and straight through the centre of the phial seal. Inject the air. Invert the phial and draw out the desired amount of gear. Once the amount is correct, withdraw the needle smartly and re-cap it immediately.

    Repeat for doses from other phials. Avoid mixing and cross-contaminating phials with different gear.

    For ampoules: now pop any ampoules you are going to use, immediately uncap the needle, draw up the contents and re-cap the needle. Do not worry about any bubbles.

    A modern chamfered multi-facet cut hypodermic needle will stand a couple of passes through phial seals without materially blunting; but needles are cheap enough, so to minimize pain and trauma discard safely any needles you may suspect are blunt.

    If you are going to change needles do so now: pull back on the plunger a little to empty the capped needle, snick it off without touching the syringe end, pop a new needle fitting through its pack without touching it and join it to the syringe immediately.

    Do not remove the needle cap.

    Dispose of the old needle safely in a sharps bin.

    Hold the syringe with the capped needle up and expel any bubbles until the gear just about enters the needle. A little air will do no harm.

    There is no need to waste gear by squirting it out of the needle; needles are pre-lubricated with PTFE or silicone and do not need wetting.

    Now you may pause if desired before injecting. The gear will be safely sterile inside the syringe with capped needle for a few hours if necessary, though it is best not to carry them around but to use them as soon as possible.

    Injecting

    Choose your injection site. Swab it well with antiseptic and let it dry.

    Assume a steady posture. Relax the muscle completely. There is no need to stretch the skin.

    Hold the syringe like a pen, uncap the needle and immediately slide it slowly 1 inch into the muscle. DO NOT STAB! Only the first mm will prick.

    If you feel an electric nerve pain or any other unusual pain at any point, pull the needle out smartly, do not touch it on anything and re-cap it. Press on the wound with a tissue. No need to change the needle. If the needle touches anything replace it. Start again at least an inch away elsewhere.

    When the needle is an inch in, pull it back out only 1 or 2 mm to ensure the tip is open: this will make aspiration easy and clear.

    Then hold the needle top steady with your free hand and ASPIRATE - pull back slightly on the plunger for 2 seconds.

    If blood enters the syringe, the needle tip is in a blood vessel and it is NOT safe to inject.

    Withdraw the needle smartly, do not touch it on anything and cap it immediately. Press on the wound with a tissue.

    It is best not to re-inject clotting blood into a muscle as this will cause a haematoma - bruise - which may be painful and take time to clear.

    Hold the syringe needle down and let the blood sink into the needle fitting. Uncap the needle and without touching it on anything expel just the blood into a tissue and recap the needle immediately. No need to change it. If the needle touches anything replace it. Start again at least an inch away elsewhere.

    On aspiration some gas bubbles may enter the syringe from the needle or fitting: do not worry about these: a little air will do no harm and will ensure all the gear is pushed into the muscle.

    If no blood enters the syringe, inject slowly - maybe 10 secs per ml.

    Experienced injectors gain a feel for how fast they can inject. Faster injection will not cause damage or PIP (post injection pain) but can be uncomfortable.

    Do not worry about a few air bubbles being injected - they will do no harm.

    When the syringe is empty, immediately withdraw the needle smartly to minimize time in the wound and trauma.

    Since you are not going to reuse the needle you can press a tissue gently against it as you withdraw it and straight onto the wound to stop any bleeding.

    Dispose of the needle safely in a sharps bin.

    Now massage the site firmly until any lump has disappeared and the gear is dispersed. There is no danger of infection from clean dry hands.

    Keep the muscle moving for some time: it's best to inject in the morning or before working out, but not before bed. This will minimize PIP.

    Used phials, ampoules and syringes - but NOT needles - may be safely disposed of in the normal rubbish.
     
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  4. Prodiver

    Prodiver Top Contributor

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    Abscesses and Treatment - Click Here for the Dedicated Thread on this Topic

    Abscesses resulting from AAS injections are painful pockets of pus in a muscle or under the skin.

    They are not caused by rough injection technique, blunt needles or by injecting large amounts: they are caused by bacteria introduced at the time of injection.

    Bacteria are introduced by lack of hygiene, unsterile drawing up or injection technique, or by contaminated gear.

    Many AAS users have injected hygienically for years without experiencing an abscess, but statistically the likelihood increases the more injections that are done.

    Some sorts of bacteria, such as fecal, are easily spread to injection sites and are extremely virulent once in skin and muscle tissue, so scrupulous hygiene is vital.

    The infectious bacteria kill local cells, causing an inflammatory response, increasing local blood flow and drawing in white blood cells which form the pus.

    The inflammatory response results in redness, heat, swelling and pain.

    The surrounding healthy cells try to stop the pus spreading the infection by encapsulating it.

    Unfortunately this encapsulation tends to prevent immune cells and antibiotics from futher attacking the bacteria.

    An abscess may become fully encapsulated, go "blind" and quiescent and gradually be absorbed, but more often worsens and spreads.

    Abscesses which spread may cause severe debility, gangrene and septicaemia and even death.

    Abscesses in most parts of the body rarely heal themselves and so require prompt medical attention as soon as suspected.

    Ultimately abscesses not cured by antibiotics may need draining and debriding, and treatment which keeps them open until they heal from the inside out.

    Rough injection technique and AAS containing excessive antiseptic may soon cause PIP (post injection pain).

    If the PIP does not subside within a day or two and the injection site is red, hot, increasingly painful, firm and swollen, sometimes with a softer centre, an abscess should be suspected and treatment started as soon as possible.

    A friendly bodybuilder Doctor says:

    "For an abscess you should be on 1000 mg (1 gram) of flucloxacillin 4 times a day for the first 4 doses, plus 1000 mg of penicillin 4 times a day for the first 4 doses, providing you don't have any renal problems.

    "You can go back to 500 mg of both 4 times a day for at least a week when the big guns hit it.

    "The penicillin is overkill but you need to hit an abscess really hard. Big doses of antibiotics fast will knock it down hopefully otherwise you're in trouble."

    If you don't have access to these antibiotics go immediately to your GP, walk-in centre or A&E and impress this upon them.
     
    WWR likes this.
  5. Prodiver

    Prodiver Top Contributor

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    Quad Injection - Click Here for the Dedicated Thread on this Topic

    To determine the best area to inject in the quads, imagine a line down the front of your quad from your hip bone to your kneecap. Divide it into 3. Take the middle third.

    Now imagine a line from your hip bone down the side of your leg. Divide the area between the front line and the side line into 3. Take the middle third.

    You now have a letter-box shaped area on the outer quarter of your middle quad in which to inject. This is where the quad muscle belly is fullest.

    If you imagine injection sites as 1 inch diameter circles around the needle entry point, you have room to do from at least 6 to maybe 12 injections, depending on your quad size.

    So alternating between your two quads you should have plenty of sites to use before you return to the first one. This will give any scar tissue ample time to disappear.

    There is no need to go into the quad deeper than an inch, in order to avoid deep nerves, lymphatic and blood vessels and the bone.

    To inject, sit on a dining chair, position your lower leg at about 45º to your thigh so the quad is fullest, and keep it totally relaxed.

    After swabbing copiously with antiseptic (Listerine), slide the needle in slowly and smoothly, and be sure to aspirate, as explained in our stickies in injecting.

    After injecting, massage the area well to ensure the gear is dispersed. It is best not to inject before bed, and good before a workout in order to keep the quad mobile, which will aid dispersal and minimise PIP.
     
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