management of acupuncture accidents Flashcards
(55 cards)
1
Q
Standard precaution
outlined by CDC re transmissible infectious agents
A
- Blood
- Body fluids
- Secretions
- Excretions except sweats
- Non-intact skin
- Mucous membranes
2
Q
Standard Precautions applied to all patients
A
- hand hygiene
- use of gloves, gown, mask, eye protection, face shield, and safe injection
practice
3
Q
Standard precautions/practices
A
- 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
4
Q
Use less number of needles or no
treatment when patient:
A
Hungry • Overeaten • Intoxicated • Exhaustion • Very weak -high BP -acute abdominal pain -acute infection
5
Q
Be careful for the high BP patients, too.
A
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
6
Q
Also be careful for the low BP patients
A
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
7
Q
During pregnancy
A
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
8
Q
Points contraindicated acupuncture points during pregnancy
A
LI 4, SP 6, UB 60, UB67, GB 21
9
Q
Infants
A
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
10
Q
Other cautions: blood, locations
A
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
11
Q
Fainting
A
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
12
Q
Fainting management
A
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
13
Q
Fainting Prevention
A
- 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
14
Q
Failure to remove needles
prevention
A
- 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.
15
Q
Stuck needle
A
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
16
Q
Stuck Needle Management
A
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
17
Q
Stuck needle prevention
A
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.
18
Q
Bent needles
A
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.
19
Q
Bent needles: management
A
1.Remove the needle slowly.
2.Move the patient to the original
posture.
3.Relax the local muscles
4.Never withdraw with force.
20
Q
Bent Needles prevention
A
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
21
Q
Broken Needles
A
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
22
Q
Broken Needles management
A
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
23
Q
Broken Needles prevention
A
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
24
Q
Hematoma
A
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
25
Acupuncture points which lie over or next to blood vessels
Acupuncture points which lie over or next to blood vessels
26
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
```
27
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
```
28
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.
```
29
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
```
30
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
```
31
Pneumothorax prevention
1. Identify the risky patients
2. 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.
3. Needle obliquely
4. Don’t place a blanket over needles in
the thoracic area.
5. Don’t cup over needles on the thorax
32
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
```
33
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
```
34
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
35
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
```
36
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
```
37
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.
```
38
Peripheral nerve injury
```
Symptoms;
- Abnormal sensation after the needle
insertion
- Difficulty of the movement of the
extremities
- Wasting of the muscles
```
39
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
```
40
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.
```
41
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.
```
42
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
```
43
Moxa accidents prevention
1. Stay with the patient during the procedure.
2. Avoid moxa on the face, within the hairline and other sensitive areas
3. Don’t do multitask during the moxa treatment
4. Monitor the skin temperature and amount of heat generated by moxa
5. Equip the room with water, fire extinguisher and air filter units
44
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
45
Cupping accidents
```
Skin reactions;
1. Bruising and hyperpigmentation
2. Burns
3. Fluid blisters
4. Panniculitis
5. Keloid scarring
6. Koebner phenomenon in psoriasis
patients
```
46
Cupping accidents: Cardiovascular
Cardiovascular accidents; (CNT
p. g.34)
1. Anemia – wet cupping
2. Hemophilia A
3. Vasovagal syncope
4. stroke
47
cupping accidents infection
Epidural abscess
Herpes simplex
HTLV-1
Staphylococcus aureus infection etc.
48
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.
```
49
Cupping -- Caution
Do not apply cupping 48 hours before or 24 hours after the chemo therapy
50
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
```
51
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.
```
52
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
```
53
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.
```
54
Gua Sha: qualified practitioners may use Gua Sha for:
```
those currently taking;
Anticoagulant
NSAIDs
Vitamin E
Fish oil
For those who have bleeding
disorders
```
55
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)
