CNT

Question 1

Safety Guidelines for NEEDLING - Critical

Answer 1

Avoid needling directly into arteries and major veins through
anatomical knowledge.
* Identify those acupuncture points which lie over or next to
major vessels:
o LU 9 Taiyuan (radial artery)
o HT 7 Shenmen (ulnar artery)
o ST 9 Renying (carotid artery)
o ST 12 Quepen (supraclavicular artery and vein)
o ST 13 Qihu (subclavian artery)
o ST 42 Chongyang (dorsalis pedis artery)
o SP 11 Jimen (femoral artery)
o HT 1 Jiquan (axillary artery)
o LR 12 Jimai (femoral artery and vein)
o BL 40 Weizhong (popliteal artery)

Question 2

Safety Guidelines for NEEDLING - Strongly Recommended

Answer 2

• Palpate subcutaneous structures, including major vessels,
  before preparing the site for insertion.
• Apply caution in patients on medications or supplements that
  thin the blood, especially elderly patients.
• To avoid superficial bleeding or hematoma, apply pressure to
  points after removing needles. Reexamine needled sites a
  second time for signs of bleeding or hematoma and if
  necessary, apply pressure.

Question 3

Safety Guidelines for NEEDLING -Recommended

Answer 3

• Visualize surface vessels and palpate those vessels
  immediately adjacent to acupuncture points being needled
  during needle insertion.

Question 4

Safety to prevent FAINTING - Strongly Recommended

Answer 4

First time pts - supine with knees slightly elevated

Question 5

Safety to prevent FAINTING - Recommended

Answer 5

• Explain acupuncture procedure in detail and answer all questions
  before acupuncture needle insertion to allay concerns and
  nervousness.
• Inform patients that they should eat 1-2 hours before acupuncture
  treatments.
• Limit needle manipulation during the first acupuncture treatment or
  until clinical assessment of the patient’s response to acupuncture has
  been established.

Question 6

Stuck Needle - Strongly Recommended

Answer 6

• Identify the recommended depth of the needle insertion for a
  particular point and utilize proper stimulation techniques for
  needles inserted below the subcutaneous level.

Question 7

Stuck Needle - Recommended

Answer 7

• Situate patients in an initial position where they are relaxed and
  not likely to need to move. Remind patients to remain still during
  acupuncture treatment.
• If a needle that was rotated in one direction becomes stuck, rotate
  the needle back in the opposite direction.
• Stimulate the area near a stuck needle with simple finger
  manipulation, tapping or another needle insertion; then try again
  to remove a stuck needle.
• Leave a stuck needle in place for a few minutes; then try again to
  remove the needle.

Question 8

Needle Removal - Strongly Recommended

Answer 8

*Count and write down the number of needles used, including
those discarded due to improper needle placement. Count the number of needles withdrawn from the patient. Confirm that the
same number of needles inserted has been withdrawn and
discarded.

Question 9

Needle Removal - Recommended

Answer 9

*Document needle counts in the patient chart.
* Keep used/empty needle packets in the treatment room until the
end of the patient’s treatment; confirm all needles removed from
packaging are accounted for either by removal from the patient,
discarded unused or discarded after contamination.

Question 10

Aggravaton of Sx - Recommended

Answer 10

• Inform the patient of the likely effects of acupuncture
  treatment.
• Advise a patient that aggravation of symptoms may be a transient outcome of treatment.
• If unexpected aggravation of symptoms occurs as a result of
  acupuncture treatment, consider consultation with or referral to another practitioner for further evaluation prior to performing
  additional acupuncture treatments.
• Provide patients with information on acupuncture therapies including practitioner contact information in the event they have questions or concerns following treatment.

Question 11

Types of Pneumothorax

Answer 11

Secondary (SPS) - d/t underlying LU dz (ie: COPD, cystic fibrosis, sarcoidosis, LU cancer, etc)
Traumatic - d/t penetrating or blunt force (stab, gunshot, severe blow)
Iatrogenic - d/t complication of diagnostic or therapeutic intervention (acupuncture)

Question 12

Safety - Pneumothorax Critical

Answer 12

• Obtain a medical history from a patient regarding lung function, lung
  diseases and smoking history before needling on the chest or back.
• Assess physique of a patient. A very tall, thin patient or one with
  atrophy or muscle mass loss from hyperinflation will have a shorter
  depth of surface to lung, increasing the risk of penetrating the lung
  resulting in pneumothorax.
• Safe needling depth to avoid pneumothorax on most patients can be as
  little as 10-20 mm.
• Limit the depth of acupuncture needle insertion to the subcutaneous
  layer and initial perimysium of the intercostal muscles.

Question 13

Safety - Pneumothorax Strongly Recommended

Answer 13

Needle at an oblique angle rather than at a perpendicular angle in the
thoracic body (from the top of the shoulders to the T-10 area on the
back, or from the top of the shoulders to the xiphoid level on the chest).
This also ensures that needles will not travel deeper into the body from
the weight of a sheet or gown used to cover the patient.
* Limit vertical manipulation of needles on the chest or back.
* Do not cup over needles on the thorax in the area of the lungs to avoid
tissue compression that can cause needle penetration to internal
organs.
* If there are indications or suspicions that an organ may have been
punctured, emergency transport should be called to take the patient to
an emergency medical facility.

Question 14

Safety - Organ & CNS Injury Critical

Answer 14

• Observe safe needling depth and angles to avoid cardiac injury.
  o To avoid penetration at a sternal foramen, use an oblique angle
  to needle on the sternum.
  o Limit the depth of acupuncture needle insertion to the
  subcutaneous layer.
• Needling Du 22 (Xinhui) in an infant is prohibited.

Question 15

Safety - Organ & CNS Injury Strongly Recommended

Answer 15

• All patient histories should include information about current or past
  diseases that might lead to a change in the size of the organs.
• Do not cup over needles on the abdomen to avoid tissue compression
  that can cause needle penetration to internal organs.
• Limit vertical manipulation of the needles on the abdomen.

Question 16

Safety - Organ & CNS Injury
Recommended

Answer 16

• If there are indications or suspicions that an organ may have been
  punctured, emergency transport should be called to take the patient to
  an emergency medical facility.
• Avoid using needles that are longer than the safe needling depth for any
  given body area.

Question 17

Safety - Traumatic Tissue Injury Strongly Recommended

Answer 17

• To reduce risk of peripheral nerve injury, avoid aggressive needle
  manipulation in anatomical areas with a record of risk such as the hand
  and wrist, ankle and fibular head.
• If a patient experiences acute severe pain from needling a point do not
  continue to manipulate the needle but withdraw to a shallower depth
  or remove it entirely.

Question 18

Safety - Prevent Broken Needles (Critical & Strongly Recommended)

Answer 18

Critical - Inspect needle for defects in manufacturing before use.
Strongly Recommended - Use only single-use sterilized needles.

Question 19

Cx Areas and Pts for Direct or Scarring Moxibustion

Answer 19

face, nipples, genitalia, hair

Caution/ CI Pts: Shangxing (DU
23), Chengqi (ST 1), Sibai (ST 2), Touwei (ST 8), Jingming (BL 1), Zanzhu (BL 2), Sizhukong (SJ
23), Heliao (LI 19), Yingxiang (LI 20), and Renying (ST 9).

Question 20

Safety - Prevent Moxa Burns CRITCAL

Answer 20

• Take a careful patient history to identify neuropathies or other
  conditions that might limit a patient’s response to pain or the
  ability to sense heat.
• During moxa therapy the practitioner must remain in the room
  at all times.
• Avoid direct moxibustion on the face, within the hairline, or in
  other highly sensitive areas.
• Anticipate and shield a patient from falling ash when utilizing
  needle-top moxa.

Question 21

Safety - Prevent Moxa Burns Strongly Recommended

Answer 21

• The practitioner should not attempt to multi-task during the
  application of moxa therapies.
• The practitioner should monitor the skin temperature and
  amount of heat generated by moxa, and not rely solely on
  patient feedback about heat sensations when utilizing any form
  of moxibustion

Question 22

Safety - Prevent Moxa Burns Recommended

Answer 22

• Rooms in which moxa is to be used should be equipped with
  water and a fire extinguisher.

Question 23

Safety - Prevent Secondary Infection from Moxa Burns

Answer 23

Critical * Prevent moxa burns.
* Paying close attention to patient comfort and skin reactions
during all treatments can prevent second degree burns, which
are more likely to become infected due to depth of tissue
damage.
* Follow Safety Guidelines for Hand Sanitation before and after
treating any burns as potentially infectious material may be
present.
* Wash all burns that do occur with cool running water
immediately.
Strongly Recommended- Measure and chart the diameter and location of any burns
occurring as a result of moxa therapies.
Recommended - Assess the amount of damage and refer to a western medical
practitioner if needed.

Question 24

Safety - Prevent Adverse Reactions to Moxa Smoke

Answer 24

Critical - Rooms in which moxibustion is performed must have proper
ventilation.
Strongly Recommended - Practitioners should utilize air filter units which include HEPA
filters when performing moxibustion.
Recommended - Consider other options for treatment instead of burning moxa for patients with a history of significant asthma or other reactions to smoke.

Question 25

Safety - Cup Disinfection

Answer 25

Critical * Clean all cups of all lubricants and biological material using soap and
water before disinfecting.
* Disinfect all cups using an appropriate FDA-cleared intermediate to
high-level disinfecting solution in accordance with label instructions.
* Use appropriate PPE while cleaning and disinfecting cups.
Strongly
Recommended
* Disinfect all cups using a high-level disinfecting solution following
package directions for semi-critical devices.
Recommended * Use disposable cups for wet cupping and dispose of used wet cups in
the biohazard trash.

Question 26

Cupping Skin Lesions

Answer 26

Critical Take a careful patient history to:
* Screen patients for the potential for reactive skin lesions such as
keloid scarring (previous keloids) and Köebner phenomenon (history
of psoriasis).
* Screen for bleeding disorders including hemophilia and Von
Willebrand’s disease.
Strongly
Recommended
* Limit the retention time of cups to that of the physical tolerance of
the patient, and the intended appearance of transitory therapeutic
petechiae and ecchymosis. Observe the process of cupping to avoid
bullae formation.

Question 27

Cupping Adverse Events - Critical

Answer 27

Critical * Cupping should not be applied 48 hours before or 24 hours after
chemotherapy treatment.

Question 28

Cupping AE - Strongly Recommended

Answer 28

Strongly
Recommended
* If a patient is taking anticoagulant and antiplatelet therapies, cupping
should be applied with an awareness of patient conditions; the
cupping process should be carefully observed.
* Limit the retention time of cups to that of the physical tolerance of
the patient, and the intended appearance of transitory therapeutic
petechiae and ecchymosis.
* Application of cupping for children should be done in the presence of
a parent or assigned guardian.

Question 29

Cupping AE - Recommended

Answer 29

• There is a risk that cupping petechiae and ecchymosis may be misinterpreted as illness, injury or abuse. It is critical to explain the therapeutic intention of cupping as well as the intended therapeutic
  petechiae/ecchymosis, and the timeline of their resolution. A handout explaining cupping in clinical practice may protect the patient from the stress of misinterpretation.