Acupuncture Safety and Adverse Events
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Questions and Answers

What is the primary therapeutic effect of acupuncture expected to come from?

  • Laser stimulation
  • Moxibustion
  • Manual pressure
  • The act of inserting, manipulating and/or retaining the needles in specific locations (correct)

    • What is the risk of serious events occurring in association with acupuncture?

  • Higher than many common medical treatments
  • Unknown due to lack of research
  • Lower than many common medical treatments (correct)
  • Equal to many common medical treatments

    • What is a necessary condition for acupuncture to be considered a generally safe procedure?

  • Performed by an untrained practitioner
  • Performed by a trained practitioner using Clean Needle Technique (correct)
  • Performed using multiple-use needles
  • Performed without any prior research

    • What is a common complication of acupuncture reported in the literature?

    <p>Both A and B</p> Signup and view all the answers

    What trend is observed in the reported serious complications of acupuncture after 1988?

    <p>A decrease in reported serious complications</p> Signup and view all the answers

    What is the primary cause of infections reported in association with acupuncture?

    <p>Hepatitis from a few practitioners</p> Signup and view all the answers

    What is a reported adverse effect of acupuncture?

    <p>Hypotension</p> Signup and view all the answers

    What is the time period covered in the literature review by Lao et al.?

    <p>1965-1999</p> Signup and view all the answers

    What is the estimated risk of a serious adverse event with acupuncture per 10,000 treatments?

    <p>0.05</p> Signup and view all the answers

    What was the percentage of adverse events reported in the Park et al. study?

    <p>4.5%</p> Signup and view all the answers

    What was the most likely moderately severe side effect reported in the Park et al. study?

    <p>Nerve injury</p> Signup and view all the answers

    What was the percentage of patients who reported adverse events in the Witt et al. study?

    <p>8.6%</p> Signup and view all the answers

    What was the most common adverse event reported in the Witt et al. study?

    <p>Bleeding/bruising</p> Signup and view all the answers

    How many hours of acupuncture-specific training did 85% of the acupuncture practitioners in the Witt et al. study receive?

    <p>140 hours</p> Signup and view all the answers

    What was the total number of reports of adverse events associated with acupuncture, moxibustion, and cupping reported by Xu et al. between 2000 and 2011?

    <p>308 reports</p> Signup and view all the answers

    What is the most important step to prevent severe bleeding and hematomas in acupuncture needling?

    <p>Avoid needling in the areas with vascular anatomy</p> Signup and view all the answers

    What is a recommended practice to prevent bleeding when removing needles from the scalp and pinna/auricle of the ear?

    <p>Hold the cotton against the scalp or pinna for a few seconds longer than other body parts</p> Signup and view all the answers

    Why has there been a significant reduction in infections associated with acupuncture in the US?

    <p>Due to the introduction of CNT course</p> Signup and view all the answers

    Why should the scalp and/or pinna be checked again after all needles have been removed?

    <p>To check for any signs of bleeding or hematoma</p> Signup and view all the answers

    What type of medications may increase the tendency for bruising and bleeding?

    <p>Anticoagulant medications</p> Signup and view all the answers

    Why should anatomical knowledge be critical in acupuncture?

    <p>To avoid needling directly into arteries and major veins</p> Signup and view all the answers

    What should be done to avoid superficial bleeding or hematoma?

    <p>Apply pressure to points after removing needles</p> Signup and view all the answers

    Why should practitioners palpate subcutaneous structures before preparing the site for insertion?

    <p>To identify major vessels</p> Signup and view all the answers

    What is a de qi response?

    <p>A desired sensation, including 'heavy,' 'tight,' 'tingling,' or other discomfort</p> Signup and view all the answers

    Why should student practitioners hone their skills prior to working on patients?

    <p>To limit the pain associated with poor technique</p> Signup and view all the answers

    What may be affected by caffeine consumption in patients with chronic pain?

    <p>Their pain perceptions</p> Signup and view all the answers

    What is hyperalgesia?

    <p>An increased response to a painful stimulus</p> Signup and view all the answers

    Why should practitioners limit the amount of needle manipulation performed?

    <p>To avoid twisting subcutaneous tissue fibers and fascia around a needle shaft</p> Signup and view all the answers

    What is a common report from patients who consume caffeine before acupuncture?

    <p>An increase in the sensation of needle insertion, particularly in anxious patients</p> Signup and view all the answers

    What is a strongly recommended guideline to prevent fainting during acupuncture?

    <p>Place a first-time patient in the supine position with the knees slightly elevated</p> Signup and view all the answers

    What is a recommended technique to manage a stuck needle?

    <p>Massage or lightly tap the skin around the point</p> Signup and view all the answers

    What is a common reason for a stuck needle?

    <p>The practitioner uses excessive manipulation of the needle</p> Signup and view all the answers

    What is a recommended guideline to prevent needle site pain?

    <p>Visualize anatomical structures while inserting the needle</p> Signup and view all the answers

    What is a reported finding about fainting during acupuncture?

    <p>More people report fainting than actually experiencing it</p> Signup and view all the answers

    What is a recommended technique to avoid stuck needles?

    <p>Identify the recommended depth of the needle insertion for a particular point</p> Signup and view all the answers

    What is a reported finding about the Chinese literature on acupuncture?

    <p>Fainting is reported more frequently than in other countries</p> Signup and view all the answers

    What is a recommended guideline to prevent fainting during acupuncture in nervous patients?

    <p>Explain the acupuncture procedure in detail before needle insertion</p> Signup and view all the answers

    What is a reported association with fainting during acupuncture?

    <p>Strong needling stimulation in a sitting position</p> Signup and view all the answers

    What should a patient be informed of prior to acupuncture treatment?

    <p>The possible aggravation of symptoms, which may be transient</p> Signup and view all the answers

    What is primary spontaneous pneumothorax (PSP) characterized by?

    <p>Air in the pleural cavity without a precipitating event</p> Signup and view all the answers

    What is the approximate rate of primary spontaneous pneumothorax (PSP) in men per year in the U.S.?

    <p>7.4/100,000</p> Signup and view all the answers

    What is the term for pneumothorax caused by a complication of a diagnostic or therapeutic intervention?

    <p>Iatrogenic pneumothorax</p> Signup and view all the answers

    According to Ernst & White, how many times did pneumothorax occur in nearly a quarter of a million acupuncture treatments?

    <p>Twice</p> Signup and view all the answers

    What is the most common symptom of pneumothorax following acupuncture?

    <p>Dyspnea on exertion</p> Signup and view all the answers

    Which group of patients is at increased risk of pneumothorax from acupuncture?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of patients with chronic lung disease?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of providing patients with information on acupuncture therapies?

    <p>All of the above</p> Signup and view all the answers

    Why may acupuncture practitioners be unaware of having created a pneumothorax?

    <p>Because patients report to an emergency department and information is not recorded</p> Signup and view all the answers

    What should you do if a needle becomes stuck during acupuncture treatment?

    <p>Rotate the needle back in the opposite direction and then try to remove it</p> Signup and view all the answers

    Why do practitioners often forget to remove needles from patients?

    <p>Due to distractions from patient care</p> Signup and view all the answers

    Where are retained needles more likely to occur?

    <p>On the chest or back, especially if there is significant hair present</p> Signup and view all the answers

    What is the purpose of documenting the number of needles inserted and removed?

    <p>To prevent the occurrence of retained needles</p> Signup and view all the answers

    What is the 'Menken or Mengen phenomenon'?

    <p>A deliberate aggravation of symptoms as an intended response to treatment</p> Signup and view all the answers

    Why should patients be warned about driving immediately after treatment if they experience aggravation of symptoms?

    <p>Because they may be experiencing fatigue and drowsiness</p> Signup and view all the answers

    Why should you avoid cupping over needles on the thorax in the area of the lungs?

    <p>To prevent tissue compression that can cause needle penetration to internal organs</p> Signup and view all the answers

    What may be an expected response to a treatment, leading to improvement of health?

    <p>Inflammation and cellular responses to stimuli</p> Signup and view all the answers

    What should a practitioner do if an aggravation of symptoms is not the expected outcome of an acupuncture treatment?

    <p>Evaluate the diagnosis and treatment plan for the patient</p> Signup and view all the answers

    What is a recommended method to reduce risk at GB 21 (Jianjing)?

    <p>Isolating and lifting the trapezius muscle with a pincer grip using the opposite hand, and needing across the muscle at GB 21 (Jianjing)</p> Signup and view all the answers

    What is a reported serious adverse event of acupuncture?

    <p>Injury to internal organs</p> Signup and view all the answers

    What is the purpose of palpating areas for forgotten needles?

    <p>To ensure that all needles have been removed from the patient</p> Signup and view all the answers

    Why should used/empty needle packets be kept in the treatment room until the end of the patient's treatment?

    <p>To ensure that all needles removed from packaging are accounted for</p> Signup and view all the answers

    How many cases of heart injury, including cardiac tamponade, were reported by Xu et al.?

    <p>5</p> Signup and view all the answers

    What is the mechanism of injury in two of the cases reported by Ernst and Zhang?

    <p>Insertion through a congenital defect in the sternum</p> Signup and view all the answers

    What is the estimated incidence of a sternal foramen at the level of the fourth intercostal space?

    <p>5-8%</p> Signup and view all the answers

    What is the recommended maximum safe insertion depth to avoid injury to the heart?

    <p>25 mm</p> Signup and view all the answers

    What is a critical consideration when needling the chest to prevent heart injury?

    <p>Angle of insertion</p> Signup and view all the answers

    What is a symptom of cardiac tamponade?

    <p>Chest pain radiating to the neck, shoulder, back or abdomen</p> Signup and view all the answers

    What is a reported adverse event of acupuncture in the Chinese literature?

    <p>Perforation of the gallbladder</p> Signup and view all the answers

    What is a critical step to take before needling on the chest or back?

    <p>Obtain a medical history from a patient regarding lung function</p> Signup and view all the answers

    What is a safe needling depth to avoid pneumothorax on most patients?

    <p>10-20 mm</p> Signup and view all the answers

    Why is it important to use an oblique angle when needling in the thoracic body?

    <p>To prevent needles from traveling deeper into the body</p> Signup and view all the answers

    What is a risk factor for pneumothorax during needling?

    <p>All of the above</p> Signup and view all the answers

    What is a common area associated with acupuncture-induced pneumothorax?

    <p>Upper trapezius</p> Signup and view all the answers

    What should be limited when needling in the thoracic body?

    <p>All of the above</p> Signup and view all the answers

    What is a reported complication of deep dry needling (DDN)?

    <p>Pneumothorax</p> Signup and view all the answers

    Why is it important to assess a patient's physique before needling?

    <p>To determine the patient's risk of pneumothorax</p> Signup and view all the answers

    What is a point frequently associated with pneumothorax events?

    <p>GB 21 (Jianjing)</p> Signup and view all the answers

    What should be avoided when needling in the thoracic area?

    <p>Placing a blanket over needles</p> Signup and view all the answers

    What is a reported complication of peripheral nerve injury from acupuncture?

    <p>All of the above</p> Signup and view all the answers

    What is a reported case of vascular injury from acupuncture?

    <p>All of the above</p> Signup and view all the answers

    What is a recommended practice to reduce the risk of peripheral nerve injury?

    <p>Avoid aggressive needle manipulation</p> Signup and view all the answers

    What is a common source of infection in acupuncture?

    <p>All of the above</p> Signup and view all the answers

    What is a group of people who may be more susceptible to infections from acupuncture?

    <p>Those with a reduction in normal immune function</p> Signup and view all the answers

    What is a serious complication of acupuncture reported in an 82-year-old woman taking warfarin?

    <p>Thigh hematoma</p> Signup and view all the answers

    How many cases of mycobacterium infection were reported between 2000-2011?

    <p>193</p> Signup and view all the answers

    What is a reported risk factor for peripheral nerve injury in acupuncture?

    <p>All of the above</p> Signup and view all the answers

    What is a precaution that can be taken to prevent infections from acupuncture?

    <p>Properly disinfecting equipment and needles</p> Signup and view all the answers

    What is a reported consequence of infection from acupuncture?

    <p>All of the above</p> Signup and view all the answers

    What is a common cause of a broken needle during acupuncture?

    <p>The patient has changed position to a great extent</p> Signup and view all the answers

    What is a possible consequence of puncturing the liver or spleen during acupuncture?

    <p>Internal bleeding</p> Signup and view all the answers

    What should the acupuncturist do if a part of the broken needle is still exposed above the skin?

    <p>Remove it with forceps</p> Signup and view all the answers

    What is the recommended needling depth to avoid cardiac injury?

    <p>Up to the subcutaneous layer</p> Signup and view all the answers

    What is the most effective way to prevent a broken needle?

    <p>Using only single-use disposable needles</p> Signup and view all the answers

    What is a common cause of splenomegaly?

    <p>Infectious mononucleosis</p> Signup and view all the answers

    Why should acupuncture practitioners use Clean Needle Technique with all patients?

    <p>To prevent infections</p> Signup and view all the answers

    What should the acupuncturist do if the broken needle is completely under the skin?

    <p>Call for emergency transport to a hospital</p> Signup and view all the answers

    What is a symptom of kidney puncture during acupuncture?

    <p>Bloody urine</p> Signup and view all the answers

    What should be done with needles or tubes that become contaminated during treatment?

    <p>They should be discarded</p> Signup and view all the answers

    Why should the acupuncturist inspect the needle for defects before use?

    <p>To prevent broken needles</p> Signup and view all the answers

    What is the distance from the surface of the skin to the spinal cord or the roots of the spinal nerves?

    <p>25-45 mm</p> Signup and view all the answers

    What should the acupuncturist do if the needle or packaging appears defective in any way?

    <p>Dispose of the defective needle in a sharps container</p> Signup and view all the answers

    What is the primary reason for using sterile instruments when breaking the skin surface?

    <p>To prevent infections</p> Signup and view all the answers

    Why should practitioners wear gloves or finger cots when handling needles?

    <p>To prevent infections</p> Signup and view all the answers

    What is a recommended practice to avoid organ injury during acupuncture?

    <p>Take a thorough patient history</p> Signup and view all the answers

    Why should the acupuncturist use the appropriate needle size and length for the location and technique to be used?

    <p>To prevent broken needles</p> Signup and view all the answers

    What should be done with unused needles from a multi-needle pack after a patient visit?

    <p>They should be discarded</p> Signup and view all the answers

    What should the acupuncturist do if the patient has a strong spasm of the muscle during needle insertion?

    <p>Stop the needle insertion and try to relax the patient</p> Signup and view all the answers

    What is a reported complication of acupuncture?

    <p>Organ injury</p> Signup and view all the answers

    Why should practitioners avoid deep needling?

    <p>All of the above</p> Signup and view all the answers

    Why should guide tubes be sterile at the beginning of the treatment?

    <p>To prevent infections</p> Signup and view all the answers

    What is a recommended action if there are indications or suspicions that an organ may have been punctured?

    <p>Call emergency medical services</p> Signup and view all the answers

    What is the recommended action if a practitioner sticks themselves with a used or contaminated needle?

    <p>Seek medical advice</p> Signup and view all the answers

    Why is it important to examine the patient for any suspected organ enlargement before administering acupuncture?

    <p>To avoid organ injury</p> Signup and view all the answers

    What is the recommended frequency for cleaning treatment room surfaces with approved disinfectants?

    <p>Daily</p> Signup and view all the answers

    Why has the risk of broken needles approached zero?

    <p>Due to the use of single-use disposable sterile stainless steel acupuncture needles</p> Signup and view all the answers

    What is the recommended action when palpating the cleaned area of skin to precisely locate the acupuncture point?

    <p>Use clean cotton or gauze</p> Signup and view all the answers

    Study Notes

    Acupuncture Safety and Adverse Events

    • Acupuncture is a generally safe procedure with a low risk of serious adverse events, lower than many common medical treatments.
    • The most common adverse events associated with acupuncture are:
      • Needle site bleeding, bruising, and pain
      • Fainting or lightheadedness
      • Aggravation of symptoms
      • Infections
    • Serious adverse events are rare, but may include:
      • Organ and tissue injury
      • Pneumothorax (air in the space between the lung and chest wall)
      • Nerve injury

    Preventing Adverse Events

    • Preventing bleeding and bruising:
      • Avoid needling directly into arteries and major veins
      • Palpate subcutaneous structures before needling
      • Apply pressure to points after removing needles
      • Re-examine needled sites for signs of bleeding or hematoma
    • Preventing needle site pain:
      • Use proper technique and avoid excessive manipulation
      • Visualize anatomical structures during needle insertion
      • Palpate subcutaneous structures before needling
      • Avoid needling into dense connective tissue
    • Preventing fainting:
      • Place patients in the supine position with knees slightly elevated
      • Explain the procedure in detail and answer all questions
      • Inform patients to eat 1-2 hours before treatment
      • Limit needle manipulation during the first treatment
    • Preventing stuck needles:
      • Identify the recommended depth of needle insertion
      • Use proper stimulation techniques
      • Situate patients in an initial position where they are relaxed
      • Remind patients to remain still during treatment
    • Preventing forgotten needles:
      • Count and document the number of needles used and removed
      • Confirm that the same number of needles inserted has been withdrawn
      • Document needle counts in the patient chart

    Aggravation of Symptoms

    • Aggravation of symptoms can occur as a result of acupuncture
    • This may be an expected outcome of treatment, known as the "Menken or Mengen phenomenon" or "healing crisis"
    • Inform patients of the likely effects of treatment and advise them that aggravation of symptoms may be a transient outcome
    • If unexpected aggravation of symptoms occurs, consider consultation with or referral to another practitioner

    Rare but Serious Adverse Events

    • Pneumothorax (air in the space between the lung and chest wall) is a rare but serious adverse event associated with acupuncture
    • This can occur as a complication of underlying lung disease or as a result of trauma
    • Reviewing the literature, pneumothorax is a rare but serious adverse event associated with acupuncture needling.### Acupuncture-Related Pneumothorax
    • 13 cases of acupuncture-related pneumothorax reported from 2000 to 2010 in China, Japan, UK, New Zealand, Singapore, and the US.
    • Symptoms of pneumothorax: dyspnea, tachypnea, chest pain, dry cough, cyanosis, and diaphoresis.
    • Patients at increased risk: cigarette smokers, marijuana smokers, those with lung disease (chronic asthma, emphysema, COPD, lung cancer), and those taking corticosteroids.
    • Patients with chronic lung disease may have a shorter distance from surface to lung, increasing the risk of pneumothorax.

    Risk Points and Safe Needling Depth

    • Primary areas associated with pneumothorax: upper trapezius, thoracic paraspinal, medial scapular, and subclavicular areas.
    • Safe needling depth: 10-20 mm to avoid pneumothorax.
    • Needling at an oblique angle recommended to prevent needles from traveling deeper into the body.

    Safety Guidelines to Avoid Pneumothorax

    • Critical: Obtain a medical history, assess physique, and limit needling depth to subcutaneous layer.
    • Strongly recommended: Needle at an oblique angle, avoid using needles longer than safe needling depth, and limit vertical manipulation of needles on the chest or back.

    Injury to Other Organs

    • Heart injury: rare but reported, can be fatal.
    • Cases of cardiac tamponade: 5 reported in 12 years, with 2 fatalities.
    • Risk of sternal foramen: 5-8% of the population, cannot be detected by palpation.
    • Maximum safe insertion depth: 25 mm to avoid heart injury.

    Safety Guidelines to Avoid Organ and Central Nervous System Injury

    • Critical: Observe safe needling depth and angles, avoid penetration at a sternal foramen.
    • Strongly recommended: Use an oblique angle to needle on the sternum, limit needling depth to subcutaneous layer, and examine patients for suspected organ enlargement.

    Traumatic Tissue Injury

    • Peripheral nerve injuries: reported infrequently, may include median neuropathy, peroneal nerve palsy, and drop foot.
    • Blood vessel injuries: rare, but reported, including compartment syndrome, deep vein thrombosis, and arterial injury.

    Safety Guidelines to Avoid Traumatic Tissue Injury

    • Critical: Follow safety guidelines to prevent bruising, bleeding, and vascular injury.
    • Strongly recommended: Avoid aggressive needle manipulation, and withdraw or remove the needle if the patient experiences acute pain.

    Infections

    • Infections may be local or systemic, due to autogenous or cross-infection.
    • One in three people are carriers of Staphylococcus aureus, and 1 in 10 is a carrier of MRSA.
    • Common skin flora: Mycobacterium, can infect wounds and prevent healing.
    • Infections associated with acupuncture: skin and soft tissue infections, including Mycobacterium abscessus and Staphylococcus aureus.

    Safety Guidelines to Prevent Infection

    • Critical: Follow Clean Needle Technique, use single-use sterile needles and lancets, and follow standard precautions.

    • Strongly recommended: Follow guidelines for hand sanitation, skin preparation, and disinfecting reusable adjunct therapy tools.

    • Discard unused needles, follow guidelines for disinfecting treatment room surfaces, and clean all treatment room surfaces daily.### Acupuncture Needling Safety

    • Palpating the cleaned area of skin is acceptable to locate an acupuncture point, but tracing fingers or hands across a wide area of skin is not recommended.

    • Applying pressure to the acupuncture point with clean cotton or gauze is acceptable after needle withdrawal.

    • Clean all office common use areas with an approved disinfectant daily.

    Broken Needle Prevention and Management

    • The use of single-use disposable sterile stainless steel acupuncture needles has significantly reduced the risk of broken needles.
    • Broken needles may occur due to manufacturing errors, poor needle quality, or improper handling.
    • Factors that can contribute to broken needles include:
      • Cracks or erosions on the needle shaft
      • Patient movement or strong muscle spasms
      • Excessive force in manipulating the needle
      • External force striking the needle
      • Bent needles being rigidly withdrawn
    • In the event of a broken needle, the acupuncturist should:
      • Remain calm and advise the patient not to move
      • Remove exposed needle parts with forceps
      • Press surrounding tissues to expose the broken end if necessary
      • Seek medical help immediately if the needle is completely under the skin
    • To prevent broken needles, acupuncturists should:
      • Inspect needles for defects before use
      • Use only single-use sterilized needles
      • Never insert a needle to the handle
      • Use appropriate needle size and length for the location and technique
      • Dispose of defective needles in a sharps container

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    Description

    This quiz reviews the literature on acupuncture, a traditional practice involving needle insertion for therapeutic effects. It covers various methods and potential risks.

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