PREVENTING ACUPUNCTURE NEEDLING ADVERSE EVENTS

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Terminology

• Adverse reactions are unexpected and undesirable effects that were not predicted or foreseen. The reasons for adverse reaction vary greatly based on the current mental, emotional, and physical status of the patient.

Managing Adverse Reactions to Acupuncture Treatment

Acupuncture is a safe procedure when conducted by trained and skilled practitioners. Practitioners are expected to identify symptoms, causes and management strategies related to the adverse reactions and accidents such as: • fainting • bent needle • stuck needle • broken needle • Hematoma

FAINTING

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Fainting

• Cause: • A patient may feel faint during acupuncture treatment.

Especially for patients that have not had previous treatments.

• Fainting can be the result of the patient being nervous, weak, fatigued, or overly hungry. It may also be the result of uncomfortable positioning, overly forceful needle manipulation, or over stimulation.

Fainting

• Symptoms during treatment of potential fainting include: – feeling ill, nausea, possible vomiting – dizziness, vertigo– oppressive sensation in the chest, palpitations – complexion or lips turn pale – More severe cases may be shown by weakened pulse,

cold hands or feet, cold sweating, lowered blood pressure or loss of consciousness.

Fainting

• Management: • If the practitioner identifies symptoms of pending fainting,

carefully remove needles and ensure the patient is lying flat on their back with head down and feet elevated. The patient should be offered sips of warm water or water with sugar.

• In most instances, patients will recover following rest, but if symptoms persist, seek medical assistance.

FAINTING

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Prevention: Avoid needling patient when their hunger or fatigue, not to forceful manipulation the needles.

What is Stuck Needle

• Following insertion of the needle, it may be difficult to rotate, lift and thrust, or withdraw.

• This situation is known as stuck needle.

STUCK NEEDLE

Cause:

This may arise from nervousness, strong spasm of the local muscle after the insertion of the needle, twirling the needle with too large amplitude or in one direction only, causing muscle fibers to bind, or from a change of the position of the patient after the insertion of the needles.

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STUCK NEEDLEManagement:

Ask the patient to relax.

If the needle is stuck due to excessive rotation in one direction, the condition will release when the needle is twirled in the opposite direction.

If the stuck needle is caused by the tension of the muscle temporarily, leave the needle in place for a while, and then withdraw it by rotating, or by massaging the skin near the point or by inserting another needle nearby to transfer the patient's attention.

If the stuck needle is caused by the changing of the position of the patient, the original posture should be resumed and then withdraw the needle. 11

STUCK NEEDLE

Prevention:

Sensitive patients should be encouraged to release their tensions.

Avoid the muscle tendons during insertion.

Twirling with too large amplitude or in one direction only shall in no case be allowed.

In the process of manipulation, the posture of the patient should remain original.

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WHAT IS BENT NEEDLE

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Manifestations:It is difficult to lift, thrust, rotate andwithdraw the needle. At the same time,the patient feels pain.

BENT NEEDLE

Cause: This may result from unskillful manipulation or too forceful manipulation, or the needle striking the hard tissue, or a sudden change of the patient's posture for different reasons, or from an improper management of the stuck needle.

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BENT NEEDLE

Management:When the needle is bent, lifting, thrusting, and rotating shall in no

case be applied. The needle may be removed slowly andwithdrawn by following the course of bend. In case the bent needle is caused by the change of the patient's

posture, move him to his original position, relax the local muscleand then remove the needle. Never try to withdraw the needlewith force.

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Bent Needle

• Prevention:• Perfect insertion and gentle manipulation are required. • The patient should have a proper and comfortable position. During

the retaining period, change of the position is not allowed. • Excessive force should not be used when manipulating needles

BROKEN NEEDLE

Cause: This may arise from the poor quality of the needle too strong manipulation of the needle from strong muscle spasm, sudden movement of the patient when the needle is in place improper withdrawal of a stuck needle or bent needle

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BROKEN NEEDLE

Manifestations:The needle body is broken during manipulation and the broken part

is below the skin surface.

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BROKEN NEEDLE

Management:When it happens, the patient should be asked to keep calm to

prevent the broken needle from going deeper into the body. If the broken part protrudes from the skin, remove it with forceps

or fingers. If the broken part is at the same level of the skin, press the tissue

around the site until the broken end is exposed, then remove it withforceps. If it is completely under the skin, surgery should be resorted to.

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BROKEN NEEDLE

Prevention:To prevent accidents, careful inspection of the quality of the needle

should be made prior to the treatment.The needle body should not be inserted into the body completely,

and a little part should be exposed outside the skin.On needle insertion, if it is bent, the needle should be withdrawn

immediately.Never try to insert a needle with too much force. If a needle that is bent during insertion should be withdrawn and

replaced by another. 20

Properly Positioning the Patient

• Practitioners must be aware that the proper positioning of patients can reduce the likelihood of fainting or of causing sudden movements that can result in bent or stuck needles.

• Depending on the area to be needled, the practitioner should carefully consider both the comfort of the patient as well as the requirements for effective and safe insertion and manipulation of the needle. Both the patient and the practitioner should feel comfortable.

HEMATOMA

Cause:This may result from injury of the blood vessels during insertion,

or from absent pressing of the point after withdrawing the needle.

Manifestations:Local swelling, distension and pain after withdrawal of the needle.

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HEMATOMA

Management: Generally, a mild hematoma will disappear by itself. If the local

swelling and pain are serious, apply local pressing, or light massage, or warming moxibustion to help disperse the hematoma.

Prevention: Avoid injuring the blood vessels.

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