Acupuncture Safety and Needle Handling

Acupuncture Safety and Adverse Events

• Acupuncture is generally considered a safe procedure with few contraindications or complications, but constant vigilance is required to maintain high standards of cleanliness, sterilization, and aseptic technique. This vigilance involves adhering to established protocols for handling equipment, preparing treatment areas, and ensuring the training and competence of practitioners. Additionally, patients should be informed about potential risks and benefits, allowing them to make informed decisions about their treatment.

• Risks associated with acupuncture include:

  1. Transmitting infections from one patient to another (e.g., HIV or hepatitis), which can occur if proper sterilization and disinfection procedures are not followed. Measures to prevent this include using single-use needles, sterilizing equipment, and following established protocols for cleaning and disinfecting treatment areas. Practitioners should also ensure that all equipment and supplies are properly packaged and labeled before use. Furthermore, patients should be screened for blood-borne pathogens and hemophilia before undergoing treatment.

  2. Injury to underlying structures, such as nerves, blood vessels, or organs, which can occur if the needle is inserted improperly or too deeply. Practitioners should use imaging guidance and electronic monitoring to ensure accurate needle placement. In the event of an accident, immediate treatment should be sought to minimize damage.

  3. Adverse reactions to treatment, such as allergic reactions to herbs or supplements used in combination with acupuncture. Patients with a history of allergies should be informed of potential risks and be monitored for signs of an allergic reaction. Practitioners should be prepared to respond promptly in case of an emergency.

  4. False diagnoses or misinformed treatment recommendations, which can occur if a practitioner lacks sufficient training, experience, or knowledge in specific areas. Patients should be informed of their condition and treatment options, and any concerns or doubts should be addressed by the practitioner.

  5. Over-reliance on acupuncture as a substitute for conventional medical care, which can lead to delayed or missed diagnoses and treatments for underlying conditions. Patients should be encouraged to work with their healthcare providers and to seek medical attention if they experience any unusual or severe symptoms.

• Risks associated with acupuncture include:

  • Transmitting infections from one patient to another (e.g., HIV or hepatitis), which can occur if proper sterilization and disinfection procedures are not followed
  • Introducing pathogenic organisms, such as bacteria or fungi, which can cause infections in patients with compromised immune systems
  • Broken needles, which can lead to inaccurate diagnoses and treatment outcomes, as well as potential harm to the patient
  • Untoward reactions, such as allergic reactions to certain substances used in acupuncture, which can range from mild to severe
  • Pain or discomfort, which can be an unpleasant but temporary side effect of treatment, or in some cases, a sign of an underlying condition
• • Inadvertent injury to important organs
  • Risks associated with other forms of therapy (e.g., acupressure, electroacupuncture, laser acupuncture, moxibustion, cupping, scraping, and magnetotherapy)
  • Inadequate training of the acupuncturist

Review of Acupuncture Safety Literature

• Early reviews of the literature conclude that the risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments.
• A review of 12 prospective studies found that the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10,000 treatments and 0.55 per 10,000 individual patients.
• Later prospective studies conclude that the vast majority of adverse events are minor and require little or no treatment.

Common Adverse Events

• Needle site bleeding and bruising
• Fainting due to acupuncture
• Tiredness
• Aggravation of symptoms
• Broken needle
• Stuck needle
• Forgotten needle
• Nerve injury
• Pneumothorax
• Local infections at the acupuncture insertion points
• Systemic infections

Preventing Acupuncture Adverse Events

• Avoid needling directly into arteries and major veins
• Palpate subcutaneous structures, including major vessels, before preparing the site for insertion
• Apply caution in patients on medications or supplements that thin the blood
• Apply pressure to points after removing needles
• Reexamine needled sites a second time for signs of bleeding or hematoma
• Visualize surface vessels and palpate those vessels immediately adjacent to acupuncture points being needled during needle insertion
• Limit needle manipulation
• Provide adequate anatomical knowledge and attention to sensations of the tissues
• Provide adequate training to practitioners

Patient-Related Factors

• Anxiety
• Nervousness
• Moving body parts during needle insertion
• Chronic pain conditions (e.g., fibromyalgia)
• Caffeine consumption
• Allodynia (painful response to a normally innocuous stimulus)
• Hyperalgesia (increased response to a painful stimulus)### Aggravation of Symptoms
• Aggravation of symptoms occurs in acupuncture, reported as a potential adverse event and as an intended response to treatment (Menken or Mengen phenomenon, or healing crisis)
• Symptoms may include immediate fatigue and drowsiness, and patients should be warned about driving immediately after treatment
• Inflammation may be an expected response to treatment, and it may signal a healing response

Pneumothorax

• Pneumothorax is a risk of acupuncture needling, occurring in 2 cases out of nearly 250,000 treatments
• It is a serious adverse event, occurring in healthy people without lung disease, and may be associated with chronic obstructive pulmonary disease (COPD), cystic fibrosis, and lung cancer
• Symptoms may include dyspnea, tachypnea, chest pain, dry cough, cyanosis, and diaphoresis
• Patients at increased risk for pneumothorax include cigarette smokers, marijuana smokers, and those with lung disease, Marfan syndrome, homocystinuria, and thoracic endometriosis
• Needling over the chest, back, shoulder, and lateral thoracic region should be limited to superficial penetration, no deeper than the subcutaneous tissue

Safety Guidelines to Avoid Pneumothorax

• Obtain a medical history from the patient regarding lung function, lung diseases, and smoking history
• Assess the patient's physique, as tall or thin patients may have a shorter depth of surface to lung
• Limit the depth of acupuncture needle insertion to the subcutaneous layer
• Needle at an oblique angle rather than at a perpendicular angle in the thoracic body
• Avoid using needles that are longer than the safe needling depth for a particular body area

Injury to Other Organs

• Injury to internal organs is a reported serious adverse event of acupuncture, including heart injury, liver injury, and injury to other organs
• Heart injury is rare, but fatalities have been reported
• Stternal foramen is a rare congenital defect in the sternum, but it can be a risk for heart injury
• Symptoms of cardiac tamponade include anxiety, restlessness, low blood pressure, and weakness
• Abdominal organ and tissue injury may occur due to needling too deeply, and symptoms may include abdominal pain, rigidity, and rebound pain

Safety Guidelines to Avoid Organ and Central Nervous System Injury

• Observe safe needling depth and angles to avoid cardiac injury
• Limit the depth of acupuncture needle insertion to the subcutaneous layer
• Avoid using needles that are longer than the safe needling depth for a particular body area
• All patient histories should include information about current or past diseases that might lead to a change in the size of the organs

Traumatic Tissue Injury

• Peripheral nerve injuries are reported infrequently, and may include median neuropathy, peroneal nerve palsy, and drop foot
• Blood vessel injuries are rare, but can result in compartment syndrome, deep vein thrombosis, and popliteal artery occlusion
• Injuries to blood vessels can result in minor bleeding or superficial hematoma

Safety Guidelines to Avoid Traumatic Tissue Injury

• Follow Safety Guidelines to Prevent Bruising, Bleeding, and Vascular Injury
• Avoid aggressive needle manipulation in anatomical areas with a record of risk
• 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

Infections

• Infections may be local or systemic, due to an autogenous source (the patient) or be a cross-infection (from the practitioner or others)
• Carriers of Staphylococcus aureus or MRSA may have no symptoms or indications they are a carrier unless they are tested
• S. aureus or MRSA can infect wounds, cause blood infection, or infect organs, bone, heart valve/lining, or lung### Acupuncture-Related Infections
• Infections associated with acupuncture are rare, but can occur when the normal barriers to infection are disrupted, such as puncturing the skin and epidermal flora.
• The majority of infections reported (193 out of 239 cases) between 2000-2011 were mycobacterium infections, including Mycobacterium abscessus and Staphylococcus aureus, including MRSA.
• The source of most infections was traced to the reuse of improperly disinfected needles or therapeutic equipment, or the use of contaminated disinfectant or gel.

Immune Function and Infections

• Patients with reduced immune function may not respond adequately to pathogens, allowing infections to start.
• Reduction in immune function can occur due to various life situations and diseases, such as stress, use of corticosteroids and other immune-suppressing drugs, or having cancer or immune-suppressing diseases like AIDS.

Clean Needle Technique

• The Clean Needle Technique is designed to limit exposure of patients and practitioners to infections.
• Critical guidelines for preventing infection include:
  • Following Clean Needle Technique
  • Following Standard Precautions
  • Following Safety Guidelines for Hand Sanitation, Preparing and Maintaining a Clean Field, Skin Preparation, and Needle Handling
• Strongly recommended guidelines include:
  • Guiding tubes must be sterile at the beginning of the treatment and not be used for more than one patient
  • Using sterile cotton or sterile gauze to stabilize the shaft of the needle when necessary

Broken Needles

• The risk of broken needles is significantly reduced with the use of single-use disposable sterile stainless steel acupuncture needles.
• Manufacturing errors, poor quality needles, or excessive force used in manipulating the needle can lead to broken needles.
• To manage a broken needle, the acupuncturist should:
  • Remain calm and advise the patient not to move
  • Remove the broken part of the needle with forceps if possible
  • Seek medical help immediately if the broken needle is completely under the skin
• Safety guidelines to prevent broken needles include:
  • Inspecting needles for defects in manufacturing before use
  • Using only single-use sterilized needles
  • Not inserting a needle to the handle

This quiz covers essential safety guidelines and proper handling of needles in acupuncture practices. It includes scenarios on broken needles, defective packaging, and compliance with single-use disposable needles.