The bulk of injectors coming into NSP are either using tourniquets, or have got to the stage where they’re groin injecting because they say they ‘have no veins left’. But from my experience most people lack basic knowledge on how to correctly use a tourniquet.
Information about what makes a good tourniquet and how to use it can give really effective fast results for injectors and help prevent the progression to higher risk sites like the groin.
Why use a tourniquet
If you use one correctly a tourniquet will increase the size of a vein considerably, this of course makes it easier to hit and so reduces the risk missed hits (that lead to abscess). But that’s only if you use a tourniquet in the right way. Used incorrectly you can increase the risks of damage to the vein, totally fail to get a vein at all or even put the entire arm at risk. That’s why it’s important to let injectors know how to use tourniquets.
The whole point is to increase the amount of blood in the arm by letting blood in, but stopping it leave. My normal approach is to ask people to tourniquet the arm just with their hand so I can get a look for veins. Nine times out of ten I end up with some bloke looking like he’s trying to rip his arm off he’ll put so much pressure on. Too much pressure and no extra blood can get into the arm; the basic idea is to increase blood pressure by letting blood in, then stopping it getting out.
You only really need a small amount of pressure. The way I normally explain this is:
… use as much pressure as you’d use holding your child’s arm as you try to get them out of a toyshop.
I then show on my own arm how putting extra pressure stops the vein coming up (which to be frank, bloody hurts). The most important thing in my opinion though is to suggest people practice this when they DON’T need to use, that way they will take more time to see the results.
What to use?
Bootlace, nice thin, dirty one with a bit of blood on….. well that’s what everyone coming in to see me seems to use anyway.
Of course that’s not what you should use. The ideal tourniquet should be:
- Wide enough to not cut into the skin
- Long enough to tie in a way that you can loosen with your mouth (see below)
- Have some give in it
The ideal tourniquet
The Chicago Recovery Alliance have been giving out great tourniquets for years now. They involve getting a bicycle inner tube (costs about £5) and cutting it in half, then cut the two halves into half lengthwise, this should give you 4 long strips of 1 inch rubber. A great, cleanable, tourniquet that can be released with the mouth (stopping the need to take your hand off the pin when you've found the vein).
You can tie these by looping around the arm and tucking it under itself, then put the rubber leading from the tuck into your mouth so it can be released BEFORE you take the shot.
Why not use a medical tourniquet?
As I've already mentioned you need to be able to release the tourniquet without removing a hand from the needle once it’s sited. Medical tourniquets are designed to be used by another person and not the person being injected.
Here though we have a problem (at least in the UK); Section 9a of the Misuse of Drugs act specifically stops us being able to legally supply tourniquets of any kind to injecting drug users. It should be noted however that in the history of the act there hasn't been a single prosecution of a drug service giving out ANY form of harm reduction equipment.
Tourniquet advice is seldom given in UK NSPs, but giving this advice can get quick, effective results and help prevent injectors progressing to higher risk sites. However, tourniquets must be correctly used and released before injecting.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.