NMT150: Naturopathic Therapeutics I - TCM E-Learning Lecture 2 PDF

NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 2 CLEAN NEEDLE TECHNIQUE Author: Dr. Romi Fung, ND, M.Sc, Ph.D (cand.) LECTURE OBJECTIVES Anatomy of a Needle Clean Needle Technique Contraindication Needle Insertion Precautions Sensations Problems w...

NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 2 CLEAN NEEDLE TECHNIQUE Author: Dr. Romi Fung, ND, M.Sc, Ph.D (cand.) LECTURE OBJECTIVES Anatomy of a Needle Clean Needle Technique Contraindication Needle Insertion Precautions Sensations Problems with Needling Needles ANATOMY OF A NEEDLE Handle Root Body or Shaft CLEAN NEEDLE TECHNIQUE Clean Technique: “Use of techniques designed to reduce the risk of infection of patients, practitioners, and office personnel by killing or reducing the strength of pathogens, thereby reducing the chances for contact between the pathogens” 1 Clean Field: “The area that has been prepared to contain the equipment necessary for acupuncture, in such a way as to protect the sterility of the needles. By extension, this includes not only the clean surface on which equipment will be placed, but also the patient's skin around the the selected acupuncture points, and anything that touches the skin” 1 CLEAN NEEDLE TECHNIQUE Basic Principles Always wash hands – 3 times Before the patient visit Prior to needle insertion (aka before needling) After removal of needles Always use sterilized needles Always establish a clean field Always immediately isolate used needles CLEAN NEEDLE TECHNIQUE Setup of Clean Field All items which are sterile or considered sterile must be placed on this area Use of a paper towel or folded gauze pad are acceptable Packaged needles, cotton, alcohol soaked cotton are all acceptable items to be placed on the clean field Needle containers and garbage bags are NOT acceptable The clean field is 3 dimensional, therefore passing non-sterile items or contaminated items over the clean field violates the field CLEAN NEEDLE TECHNIQUE Sterile Needles All pre-packaged needles come sterilized from the manufacturer All needles have expiry dates clearly indicated on the outside of the box Most needles will have the method of sterilization written on the box (e.g. Ethylene oxide) The inside of the bubble package is considered sterile Do not expose the needle or tube to non-sterile areas prior to insertion Your hands are NOT considered sterile but you may handle the outside of the tube and handle of the needle before insertion CLEAN NEEDLE TECHNIQUE Sterile Needles The shaft of the needle must remain sterile as it is the portion of the needle that will penetrate the skin If you need to rest the needle down before insertion and the tube no longer exists, you must find an object that is sterile to rest the needle shaft on within the clean field Examine all needles prior to insertion to ensure a smooth texture and any possible integral deficits Needle handles that are discolored, especially Chinese needles, must be appropriately discarded CLEAN NEEDLE TECHNIQUE After needling is complete, all needles must be discarded in a BIO_HAZARD SHARPS container DO NOT WALK WITH THE NEEDLES TO THE CONTAINER, BRING THE CONTAINER TO THE PATIENT PRIOR TO WITHDRAWAL Do not attempt to remove more than one needle at a time Do not attempt to hold more than one needle at a time Any blood-borne products must be discarded in specific containers All other waste may go in the garbage CLEAN NEEDLE TECHNIQUE Universal Precautions “Health care workers must assume all patients are infected with HBV or HIV, thus taking adequate non-discriminatory precautions to protect themselves”1 Pertains to: Blood, body fluid containing visible blood, semen, vaginal secretions, tissues, CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid CLEAN NEEDLE TECHNIQUE Contraindications The following conditions need to be avoided before and after treatments Alcohol intoxication - Absolute Exhaustion - Absolute Severe fear – hard to control after tx but do no treat anyone suffering from it before Sexual intercourse - Relative Over eating - Relative Hunger - Relative Excessively thirsty - Relative Strenuous exercise - Relative CLEAN NEEDLE TECHNIQUE Needle Insertion 1. Wash hands 2. Prepare clean field including all equipment required 3. Locate point(s) to be needled and create a mark using a tube by twisting it gently yet firmly to leave a visible mark 4. Cleanse each point with a separate piece of cotton soaked in 70% isopropyl alcohol using one quick swipe over the area of the point, then allow to air dry 5. Once the skin is dry, remove a needle from the package and inspect it 6. Place tube over the cleansed area and allow needle tip to fall to the surface of the skin CLEAN NEEDLE TECHNIQUE 7. Give a firm tap to the top of the needle handle allowing for the tip to penetrate the skin 8. Once the needle has entered, remove the tube from around the needle and ensure that the needle does not fall over 9. Using only the handle of the needle, gently yet firmly insert the needle to the desired depth. Twist the needle in both directions as you penetrate deeper or gradually insert the needle without twisting. CLEAN NEEDLE TECHNIQUE Notes on Needle insertion Prior to insertion, depth and angulation must be researched Choose the appropriate length and gauge of needle for the area to be needled i.e. Longer for thicker areas, shorter for thinner areas, thicker gauge needles for tough, thick areas, and thinner gauge needles for thin, soft areas CLEAN NEEDLE TECHNIQUE Precautions to Needling Deep needling on the posterior neck Brain Stem, vertebral artery Points on the chest, hypochondriac region and back Organs especially the lung Near big blood vessels Carotid, jugular, radial, femoral, superficial temporal, popliteal ST 17, CV 8 are not to be needled CLEAN NEEDLE TECHNIQUE Normal Sensations or De Qi (Obtaining Qi) Aching Soreness Tingling Distention Heaviness Itching Electrical sensation Burning CLEAN NEEDLE TECHNIQUE Abnormal Sensations Sharpness Spastic contraction of the limbs Convulsions Fainting Loss of color in the face Sharpness is usually due to the needle point touching in a sensitive layer like fascia, vessels, or even nerve fibres CLEAN NEEDLE TECHNIQUE Needle Manipulation There are various techniques used to stimulate Qi or cause De Qi Leaving the needles in for 15 minutes Tapping and Flicking Tonifying methods Holding Channel Qi: manipulating at certain times Moving Qi: Usually by tapping or pressing along the meridian adjacent to the point needled CLEAN NEEDLE TECHNIQUE Problems with needling Needle-stick Injury Stuck needle Bent needle Broken needle Fainting Arterial Puncture Hematoma Pneumothorax NEEDLE STICK INJURY PROTOCOL Inform your teaching assistant or instructor immediately Encourage bleeding from the site Both parties must give a full report of the incident to the instructor The injured party will be accompanied to the Emergency Department at North York General Hospital for HIV and Hepatitis testing Follow up testing should be performed at six weeks, three, six, and twelve months after the incident The host party is encouraged to also be tested for HIV and Hepatitis If the HIV/Hepatitis status is known, it should be disclosed to all parties involved The host is not required but strongly urged to disclose this information CLEAN NEEDLE TECHNIQUE Stuck Needle The needle is very hard to rotate, twist, lift or thrust Causes: Movement of the patient causing the needle to trap under or next to structures Too strong of a stimulation or over-rotation in one direction Muscle spasm The needle shaft was inserted into the tendon and rotated with a large angle CLEAN NEEDLE TECHNIQUE Stuck Needle Management Correct patient position Allow patient to relax if tension is causing the spasm or massage areas adjacent to the point to relieve tension In over-rotation, rotate the needle in the opposite direction and shake left and right gently to loosen it CLEAN NEEDLE TECHNIQUE Bent Needle Shaft of the needle is bent while in the patient Causes: Poor technique Strong manipulation Patient position has changed Handle bending from foreign body or structure Poor management of a stuck needle CLEAN NEEDLE TECHNIQUE Bent Needle Management With slight bends of the shaft, withdrawal of the needle, slowly and gently without twisting With large bends, the needle should be wiggled gently first then removed according to the bent angle With multiple bends, the needle must be slowly removed following the bends of the needle Correct patient position CLEAN NEEDLE TECHNIQUE Broken Needle Either broken outside of the skin or within the skin Causes: Poor needle quality Too strong manipulation Patient position changed Foreign body impaction of the handle Poor management of a bent or stuck needle Sudden violent electrical stimulation during electro-acupuncture CLEAN NEEDLE TECHNIQUE Broken Needle Management Remain calm and ask patient to remain calm and have them remain in their position If the broken portion is above the skin, remove it with forceps or locking hemostats If the broken portion is at or near the skin, gently press down with your index finger and thumb and remove the broken fragment with forceps or locking hemostats If the broken portion cannot be removed and is near an important area of the body, they will require removal using x-ray and surgery In non-important areas, the broken portion can be left in but checked on periodically CLEAN NEEDLE TECHNIQUE Fainting Sx: Pale face, light headed or dizzy, stuffy or tight chest feeling, SOB, rapid heart beat (tachycardia), cold sweat on forehead first then the 4 limbs and back, nausea, general lassitude, deep, thready pulse Causes: Weak constitution, excess mental tension, over stressed Severe perspiration, excess hunger, severe diarrhea or bleeding Incorrect position or strong manipulation CLEAN NEEDLE TECHNIQUE Fainting Management Stop needling and remove all needles Lie patient down with feet higher than the head Keep patient warm either passively or with tea or water For more severe cases, needle GV 26, St 36, Pc 6 and Kd 1 or moxa GV 20, CV 4 or 6 Recovery generally takes.5 to 1 hour If the patients condition continues to decline, and their blood pressure continues to drop, send them to the ER CLEAN NEEDLE TECHNIQUE Arterial Puncture Puncture of an artery which causes blood under pressure to be ejected from the puncture site Management Apply direct pressure with ice for 5 minutes for small arteries In the case of a larger artery puncture, contact emergency services immediately Depending on location, allow blood to flow back toward the heart Ie. Raise legs for femoral artery puncture or raise arm for radial artery puncture CLEAN NEEDLE TECHNIQUE Hematoma Bruising or swelling around the punctured area after removal of the needle Causes Small blood vessels are punctured Hooked tip of the needle causes bleeding Management Self limiting Cold compress followed later by a hot compress or moxa or gentle massage Bleeding cupping to remove stagnation CLEAN NEEDLE TECHNIQUE Pneumothorax Puncturing the lung causing chest pain, stuffy feeling in the chest, SOB. Severe cases manifest as shock, dyspnea, tachycardia, cyanosis, severe sweating, falling BP, prostration… Causes Deep needling in the chest, back or shoulder area Incorrect angulation CLEAN NEEDLE TECHNIQUE Pneumothorax Management Place patient in lateral recumbent position Mild cases will heal in 1-2 weeks and patients should be monitored during that time Severe cases require emergency 911 TYPES OF NEEDLES Needle Types used in practice Filiform needle Standard solid needle used universally Chinese – all metal, stainless steel Japanese – plastic handles, silicon coated shaft Korean – all metal with a heavy handle Ear Tacks Small needles with an adhesive backing Used mainly for auricular acupuncture Can remain in for days Grain Type needles Small needles that can be inserted sub-cutaneously and covered with tape Can remain in for days TYPES OF NEEDLES Needles comes in a variety a sizes Length: 0.5 cun (inches) – 6 cun Gauge (diameter of shaft):.18 cm -.45 cm #38 - 26 REFERENCES National Acupuncture Foundation, Clean Needle Technique Manual for Acupuncturists – Guideline and Standards for the Clean and Safe Clinical Practice of Acupuncture, 4th ed, 1997 Chinese Acupuncture and Moxibustion, Beijing Press