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Clean Needle Technique for Acupuncture

Clean Needle Technique

Infection Control – Practitioner’s Hygiene

Physical cleanliness includes not only adequate hand washing but also includes such things as wearing clean clothes (i.e. lab coat), long hair tied back, and nails being kept clean and short. Cuts/abrasions should be covered by and band-aid and/or glove. Do not work with an upper respiratory condition.

Hand Washing –

Practitioner should wash their hands before and after each patient contact. Soap with an antibacterial agent is preferred and strongly recommended. Clean paper towels should be used to dry the hands. When washing your hands, friction and running water are very important to help remove surface germs from the epidermal layer of the skin.

Germ Theory –

If a sterile object touches a non-sterile surface, the object is no longer sterile. All needles must be properly sterilized for needle insertion. The shafts of the needle, especially longer needles, can be stabilized with a sterile cotton ball or sterile gauze. If the needle touches any object (i.e. pants, clothing, bed) or if it is dropped on the floor, the needle is considered contaminated and should not be used. All used alcohol swabs and needle packaging must be disposed of from a clean area. Suction cups that come in contact with the skin require either sterilization or disinfection prior to each use.

Packaging –

All needles that are packaged should be checked for sterilization expiration dates. Any package that is wet, torn, or expired is no longer considered sterile.

Types of Sterilization
1. Steam
2. Boiling
3. Dry heat sterilization
4. Chemical sterilization

Disinfection
3 Types of Disinfection
1. Halogen – includes chlorine and
2. Phenol – pure phenol is derived from coal tar
3. Alcohol – two types of alcohol: Isopropyl and Ethyl

Antisepsis
There are 3 types of Antisepsis
1. Iodine
2. Alcohols
3. Hexachlorophenes

Iodine is a popular antiseptic, and it is used in concentrations of 70%-90%. Be careful with using iodine, as it can leave permanent stains on clothing. Isopropyl Alcohol is an effective antiseptic as well. Always keep the lids of alcohol bottles closed to keep the 100% concentration. When swiping the skin, the cotton ball or swab should be applied in one fluid wipe. Do not wipe the skin in a back-and-forth or circular motion. Alcohol should not be applied to mucous membranes or open wounds.

Needle Disposal

All needles must be discarded in proper sharps containers according to Public Health Regulations. Alcohol swabs or cotton balls should be discarded into the trash unless they are completely soaked in blood.

Iatrogenic Complications

1. Forgotten Needle: There have been instances where a practitioner has forgotten to take a needle out. Practitioners should try to keep a needle count. This may reduce the risk of forgotten needles. A forgotten needle could cause possible harm/injury.

2. Broken Needle: Very thin needles (> 34 gauge) are more susceptible to break during insertion. A broken needle with the shaft visible above the skin may be safely removed in a sterile clamp, but if a needle has broken and it is beneath the surface of the skin, it will require a medical referral.

3. Locked or Stuck Needle: Locked or a stuck needle can result from muscle spasms or if the patient moves. The result in a stuck needle because the muscle tissue around the needle spasms and locks the needle in place. When this occurs the needle should never be forcibly removed. You must stop the electro-acupunctoscope and allow the patient to rest. Gently massage the area or meridian of the stuck needle helps with the release of the needle. If the stuck needle is a result of the patient moving, the patient should assume original position then the needle can be taken out.

Pneumothorax

It is one of the most commonly reported complications of Acupuncture in the Medical Literature. A pneumothorax occurs when the surface of the lung is punctured, allowing air to leave from the lung into the pleual cavity. The most common point involved is GB21 and points around the neck and shoulder girdle. The best prevention is the use of correct needle depth and angle.

Blood Vessel

Puncture of small superficial veins is not uncommon. When this occurs, one must apply pressure on the affected site for about one minute. The Practitioner should always inform the patient of a hematoma. Arterial puncture is more serious. You must apply firm pressure for about 3-5 minutes for bleeding of a small artery.

Organ Puncture

All organs are susceptible to being punctured if needled incorrectly. The organs that are more susceptible to being punctured are the bladder, kidneys, enlarged spleen or liver. And the peritoneal cavity. If one is needling lower abdominal points, as the patient to empty their bladder.

Spinal Cord Trauma

Loss of sensation or movement can result from a needle that penetrates the spinal cord.

Neuritis

Inflammation of the nerve can result from needling directly over nerves or from needling using strong electric stimulation. If the nerve is inflamed, the patient could experience numbness, electrical sensation or motor weakness.

Infection

Allergic Dermatitis

Signs and symptoms include redness of skin, an itching/burning sensation, and pain or discomfort at the site of insertion. Acupuncture needles containing nickel and chromium have been known to cause allergic dermatitis.

Miscellaneous Infections

Miscellaneous infections that can occur, include septicemia, osteomylitis, bacterial endocarditis, meningitis and hepatitis. The only methods of prevention for these conditions are the use of sterile needles and identification of high-risk patients.

Other Complications or Side Effects

1. Nausea – nausea may be experienced by the patient if strong parasympathetic stimulation occurs during needling. Needles should be withdrawn immediately if nausea or vomiting persist.

2. Normal Side Effects – You will often hear comments such as “I feel light-headed” or “mild disorientation” or “euphoria”. These are all normal side effects of acupuncture. Sometimes the patient may also feel cold with prolonged needle retention (more than 20-30 minutes).

Contraindications to Treatment

People who are under the influence of drugs or alcohol, those with an empty stomach, those who are emotionally unstable or those who have just finished physical exertion should not be treated with acupuncture.

Contraindications of Electro-acupuncture

When using the electro-acupunctoscope, the current should never cross the back or the chest. The two branches of the same electrode should always be on the same side of the patient’s body. Electro-acupuncture is contraindicated during pregnancy and in those patients with any type of cardiac pacemaker.

Pregnancy

Traditional Chinese Medicine recommends against needling during any asymptomatic, normal pregnancy. If there are symptoms, needling specifically towards the symptom is allowed.

Electrical Stimulation & Acupuncture

Waveform/Frequency/Intensity
Specifications for model AWQ-104E

• Pulse Shape: Biphasic Rectangular Wave
• Pulse width: 350 uS at X1, 40us at X10
• Pulse rate (frequency): 1-120Hz at X(1) 10-1200Hz at X(10)
• Wave form: adjustable, dense-disperse, intermittent
• Output current (intensity): 0-18mA (Lo) 0-40mA(Hi)
• Channel: 4
• Point detector

Manipulation

• Make sure that you examine the electro-acupunctoscope before each use.
• Insert the needle (with metal handle) and get Qi sensation
• Make sure all the knobs are turned to zero before hooking the electro-acupunctoscope to the needles.
• Connect the electrical stimulator with needles.
• Turn power on.
• Adjust the electro-acupunctoscope to the appropriate waveforms and frequency
• Adjust the intensity to a comfortable level.
• If intensity “Hi-Lo”switch, or frequency “1-10″switch, or polarity need to be changed, the output intensity (and frequency sometime) should be turned down to zero.
• Treatment should last 15-20min
• Make sure all the knobs to zero before turning off the power and take away the conducting wire.

Notes:
• 2 needles complete a circuit
• Connect negative end to primary point, positive end to secondary point

Waveforms

Dense wave (continuous)
High frequency: 50-100 pulses per second
Function and indications:
Inhibit sensory nerves and motor nerves
Relieve pain, calms the mind, relieve spasm of the muscles

Disperse /Sparse wave (continuous)
Low frequency: 2-5 pulses per second
Function: Induce the contraction of muscles, and enhance the tension of muscle and ligament.
Indication: injury of muscle, ligament and joints.

Dense-disperse wave
Disperse wave and dense wave appear alternately, each last about 1.5 s. Prevent the body’s adaptation
Function:
Relieve pain, improve function of the organs, improve qi and blood circulation, improve the nourishment of tissues, reduce inflammation
Indication: Pain, trauma, sprain, arthritis, sciatica, facial paralysis, weakness of muscles, etc.

Intermittent wave
A wave appears on and off rhythmically. Interval: 1.5s
Function: Stimulate the muscles
Indication: Paralysis.

Precautions/Contraindications

• Turn up the intensity of the electro-acupunctscope gradually so we can avoid incidences such as muscle contraction, broken needle and bent needle resulting from increased intensity.
• Number one priority is to keep the patient comfortable at all times.

• Mild stimulation is required when applying electro-acupuncture near the spine and brain stem.

• When applying electro-acupuncture on chest and back area in the region of the heart, do not connect points across two sides of the body to avoid the current passing through the heart.

• Do not apply stimulation in the region of the heart.

• Do not apply stimulation to patients with pacemakers or other electronic implants.

• Use electro-acupuncture cautiously for patients who have heart diseases, seizures, and pregnant women.

• Electro-acupuncture should be used cautiously for patients who are aged or weak.

Disease treatment

Advantages

1. Better for nerve-related problems
2. Stimulation is more measurable than manual
3. Many points can be stimulated at the same time (manual can stimulate only one at a time)
4. Stimulation can last longer. A typical treatment is usually 20 minutes. If you are stimulating manually, you usually only stimulate for a couple of minutes at the most.

• Points are selected in pairs
• Usually unilaterally
(Pair on same side left or right Do not cross from one side to another as that may interfere with heart action)

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