management of acupuncture accidents Flashcards
Standard precaution
outlined by CDC re transmissible infectious agents
- Blood
- Body fluids
- Secretions
- Excretions except sweats
- Non-intact skin
- Mucous membranes
Standard Precautions applied to all patients
- hand hygiene
- use of gloves, gown, mask, eye protection, face shield, and safe injection
practice
Standard precautions/practices
- Assume all patients are a potential source of infection.
- Utilize correct and frequent handwashing.
- Use PPE(personal protective equipment) appropriately
- Equip appropriate engineering controls, e.g. Handwashing stations
- Discard sharps in appropriate sharps containers.
- Discard contaminated medical waste in a red bag of other appropriate container.
- Use disinfectants correctly.
- Handle sharps appropriately
Use less number of needles or no
treatment when patient:
Hungry • Overeaten • Intoxicated • Exhaustion • Very weak -high BP -acute abdominal pain -acute infection
Be careful for the high BP patients, too.
normal 120/80
elevated 120-129/80
high stge 1 130-139/80-89
high stge 2 140+/90+
hypertensive 180+ and/or 120+ (send to ER)
use acupuncture to stim parasympth system
check BP every point- no exception
Also be careful for the low BP patients
What is Low BP? - Systolic : less than 90mmHg or - dystonic: less than 60mmHg • Causes– many reasons, can be serious • Symptoms- fainting, dizziness, blurry vison, nausea, fatigue, lack of concentration. Extreme hypotension is life threatening! Confusion Cold, clammy, pale skin Rapid, shallow breathing Weak and rapid pulse
During pregnancy
1) Under three month— lower abdomen, Lumbosacral region
2) After three month– Upper abdomen, Lumbosacral region,
Points causing strong sensation
3) Points contraindicated acupuncture points during pregnancy
LI 4, SP 6, UB 60, UB67, GB 21
Points contraindicated acupuncture points during pregnancy
LI 4, SP 6, UB 60, UB67, GB 21
Infants
Contraindications;
a. Points on vertex – before fontanel closes
b. Needle retention
Yellow emperor: dont treat children w/ acupuncture; use contact needling
Japanese: do treat children but not with puncture-just pressure needle
Other cautions: blood, locations
Avoid! Blood vessels Careful! 1. Points on the chest, back and abdomen e.g. Ren15 1. Points close to the vital organs e.g. S1 1. Points close to the large blood vessels e.g.Sp11
Fainting
Causes: 1. nervous tension 2. delicate constitution 3. hunger 4. fatigue 5. improper position 6. forceful manipulation Symptoms: dizziness, vertigo, palpitations, SOB restlessness, nausea, pale face, cold sweating, weak pulse if severe: 1. cold extremities 2. drop of BP 3.loss of consciousness
Fainting management
Management; 1. Stop needling immediately 2. Withdraw all the needles 3. Help the patient to lie down 4. Offer the patient warm or sweet water www.ja.Wikipedia.org (If not much improvement) press: DU 26, DU 25, PC6, PC 9, ST 36 moxa: DU 20, REN 4, REN 6
Fainting Prevention
- Place a first-time patient in the supine position with the knees slightly
elevated for the first acupuncture treatment - Explain acupuncture procedure in detail and answer all questions before
acupuncture needle insertion - Inform patients that they should eat 1-2 hours before acupuncture
- Limit needle manipulation during the first acupuncture treatment
Failure to remove needles
prevention
- Count and write down the number of needles used. Count the number of
needles withdrawn from the patent. Confirm that the same number of needles
inserted has been withdrawn and discarded. - Document needle counts in the patient chart.
Stuck needle
causes: 1. nervousness 2. strong spasm of the local muscles after the needle insertion 3. twisting of needles 4. change of posture symptoms: difficulty of moving needles
Stuck Needle Management
management 1. Ask the patient to relax. 2. if caused by twisting of needles -- twist toward opposite direction 3. if caused by muscle spasm - leave the needle for a while and withdraw - massage the skin near the point - insert another needle nearby 4.if caused by change of posture - Ask the patient to return to original
Stuck needle prevention
prevention
- Relax the patient
- Avoid the tendons.
- Don’t rotate the needle only to one direction.
- Don’t let the patient to change position with the needles on.
Bent needles
causes: 1.unskillful manipulation 2.too forceful manipulation 3.sudden change of the patient’s posture 4.improper management of stuck needle manifestation: Needles are difficult to move. If moved forcefully, pain occurs.
Bent needles: management
1.Remove the needle slowly.
2.Move the patient to the original
posture.
3.Relax the local muscles
4.Never withdraw with force.
Bent Needles prevention
1.perfect insertion and gentle manipulation 2.proper position of the patient 3.no change of the position during the treatment 4.no external force on the needling area
Broken Needles
causes: 1.poor quality of the needle 2.forceful needling 3.strong muscle spasm 4.sudden movement of the patient 5.from withdrawing a stuck needle manifestation: One part of the needle is left in the body
Broken Needles management
1.Ask the patient to stay calm.
2.If one part protrudes from the skin
Use the forceps or fingers to take it
out.
3.If the broken part is at the same level
of the skin
Press the skin around the needle
down and use forceps.
4.If completely under the skin - surgery
Broken Needles prevention
1.Inspect the quality of the needles carefully. 2.Don’t insert the all length of the needle body into the skin. 3.Don’t needle forcefully. 4.If needle is bent, take it out immediately
Hematoma
Acupuncture points which lie over or next to blood vessels; Lu9 ( radial artery) H7 (ulnar artery) S9 (carotid artery) S12(supraclavicular artery and vein) S13(subclavian artery) S42(dorsalis pedis artery) Sp11(femoral artery) H 1(axillary artery) Liv12(femoral artery and vein) B40(Popliteal artery
Acupuncture points which lie over or next to blood vessels
Acupuncture points which lie over or next to blood vessels
After effects of needling
causes unskillful needle technique manifestation uncomfortable feeling of soreness and pain for a long time after the treatment prevention careful and gentle needling
Needle site pain causes
Causes; 1. Poor needling technique 2. Alcohol remaining on the skin 3. Needling into dense connective tissue (tendons, periosteum, perimysium) 4. Patients with chronic pain (allodynia, hyperalgesia) 5. Caffeine consumptions
Needle site Pain prevention
1. Allow alcohol to dry before needling 2. Visualize anatomical structures during treatment 3. Don’t confuse De qi with painful needling technique.
pneumothorax symptoms
Symptoms -chest pain – dry cough -fullness of the chest -difficult breathing -movement of trachea toward the unpunctured side -shock - cyanosis – sweating - lowered blood pressure
pneumothorax: increased risk
Patients at increased risk for pneumothorax 1. Cigarette smokers 2. Marijuana smokers 3. Chronic lung diseases 4. A tall very thin patient 5. Patient with atrophy or muscle mass loss
Pneumothorax prevention
- Identify the risky patients
- Do not needle deep over the chest,
back, shoulder and lateral thoracic
region (no deeper than the
subcutaneous tissue). Safe needling
depth is 10-20 mm. - Needle obliquely
- Don’t place a blanket over needles in
the thoracic area. - Don’t cup over needles on the thorax
Pneumothorax danger points
Points most frequently associated with pneumothorax GB21, B13, B18, S11, S12 - 18, Ren 14, Ren 15, Ren22, SI 9, SI13,Dingchuan, L2, K22-27
Pneumothorax lung anatomy
Lung anatomy The apex of the lung extends 2-3 cm above the clavicular line. The lower border is the level of the lower border of T10 Needle obliquely; - From the top of the shoulders to the T10 area on the back - From the top of the shoulders to the xyphoid level on the chest
HT puncture (HT tamponade)
Symptoms; - SOB
- Chest pain that gets worse with deep breathing or coughing
- Chest pain that radiated to the neck, shoulders, back, or abdomen
- Low BP
- Difficulty of breathing, rapid breathing
- Discomfort that is relieve by sitting or leaning forward
- Shock
- Anxiety
Heart anatomy : location
Left superior border= the 2nd intercostals space, 2-3 cm away from the midline. Right inferior border= the 6th intercostals space. apex =left the 5th intercostals space 7-9 cm away from the midline
CNS injury – spinal cord injury
Symptoms; - Sharp pain extending to the extremities (Can cause neuritis) - Continuous pain - Numbness - Functional impairment along the path of the nerve
spinal cord location
The distance from the surface of the skin to the spinal cord or the roots of the spinal nerves ranges from 25- 45 mm. Deep needling of UB inner line particularly cause lesions of spinal cord or the spinal nerve roots.
Peripheral nerve injury
Symptoms; - Abnormal sensation after the needle insertion - Difficulty of the movement of the extremities - Wasting of the muscles
Nerve locations
Lu 5 – injury of the radial nerve, difficult movement of the fingers (especially abduction of the thumb) PC 3 – injury of the median nerve, difficulty of flexion/extension of the fingers SI 1, 3, 4, HT 7 – injury of the ulnar nerve, causes claw hand deformity SP 6, 5, 8 – tibial nerve injury ST 39, 40 – peroneal nerve injury
Infrared and TDP lamps accidents
Caution; 1. The heating element in the lamp may reach a temperature that will burn a patient. 2. Some lamps may slowly lower during the course of a treatment.
TDP lamp accident prevention
may reach a temperature that will burn a patient. 2. Some lamps may slowly lower during the course of a treatment. Prevention; 1. Make sue the lamp is working properly. 2. Do not use on infants, children, incapacitated persons, or sleeping or unconscious persons. 3. Prevent water, moisture, liquids or metal objects from coming in contact with the lamps. 4. Monitor the skin temperature closely. 5. Be careful for the patients whose sensation is compromised.
Moxa Accidents
Avoid Burns (except the direct moxa) - Protect the patient’s skin from any falling moxa or ashes Caution; • Patients with diminished sensitivity - Neural injury - neuropathies - Diabetes mellitus - Paralysis
Moxa accidents prevention
- Stay with the patient during the procedure.
- Avoid moxa on the face, within the hairline and other sensitive areas
- Don’t do multitask during the moxa treatment
- Monitor the skin temperature and amount of heat generated by moxa
- Equip the room with water, fire extinguisher and air filter units
moxa accidents management
Management;
Measure and chart the size and the location
of the burn. • A very small first degree burn
- Run cool water over the burn (not ice) - Apply sterile gauze - May apply OTC burn cream
• A severe burn
- May get infected
- Refer the patient to the physician
Cupping accidents
Skin reactions; 1. Bruising and hyperpigmentation 2. Burns 3. Fluid blisters 4. Panniculitis 5. Keloid scarring 6. Koebner phenomenon in psoriasis patients
Cupping accidents: Cardiovascular
Cardiovascular accidents; (CNT
p. g.34)
1. Anemia – wet cupping
2. Hemophilia A
3. Vasovagal syncope
4. stroke
cupping accidents infection
Epidural abscess
Herpes simplex
HTLV-1
Staphylococcus aureus infection etc.
Cupping accidents prevention
1. Check the temperature of the cup before applying on the patient. 2. Avoid cupping over lesions, rashes, injuries or breaks in skin barrier 3. Disinfect cups using an appropriate FDA-cleared intermediate to highlevel disinfecting solutions. 4. Do not cup too deep or too strong . 5. Screen for bleeding disorders including hemophilia and Von Willebrand’s disease.
Cupping – Caution
Do not apply cupping 48 hours before or 24 hours after the chemo therapy
Electrical Acupuncture
Needles; Stainless steel needles Avoid; 1. Silver needles 2. Needles with plastic handle 3. Very thin needles Contraindications; 1. Patient with implanted electrical devices
Electrical Acupuncture: appropriate current
0.5 – 0.6 mA The level of electrical stimulation should remain just below the level of pain as perceived by the patient. Avoid muscle contraction.
Electrical Acupuncture; Anatomical considerations
Avoid 1. Anterior triangle of the neck 2. Posterior cervical area 3. Crossing the spine 4. Crossing the heart 5. The needles placed far apart 6. Patient with implanted medical device
Gua Sha
Contraindication; 1. Over rash or broken skin, swelling, inflammation, burn or sunburn. 2. Do not apply Gua Sha 48 hours before or 24 hours after chemo therapy. Gua sha is not contraindicated for patients with a stable INR who are taking anticoagulant medication.
Gua Sha: qualified practitioners may use Gua Sha for:
those currently taking; Anticoagulant NSAIDs Vitamin E Fish oil For those who have bleeding disorders
Plum blossom needling
Contraindications and cautions;
1. The treatment area must be clean and free of any skin lesions or traumatic
injury.
2. Wear PPE (gloves)
