Missed Hits

What they are, how they happen, what to do and how to avoid them.

‘Missed hit’ is a term to describe swelling which appears around an injection site during or immediately after an injection. It may be caused by fluid entering the tissue surrounding the vein because the needle has:

• Not entered the vein properly
• Entered the vein and slipped out again
• Entered the vein and gone through the opposite wall
• Entered the vein correctly but excess pressure has caused the vein to split

These problems can be prevented by encouraging injectors to:

• Check that the needle is in a vein by gently pulling back on the plunger to see that venous blood enters the syringe
• Always releasing the tourniquet before injecting
• Maintain a steady hand while injecting
• Smoke a small amount of heroin before injecting if in opiate withdrawal
• Use the smallest possible needle and syringe barrel
• Inject at the correct angle
• Inject the fluid slowly

A missed hit will mean that the drug is absorbed much more slowly and could also lead to other problems such as abscesses, cellulitis and other infections.