Clean needle technique
Infection control: professional hygiene
Physical cleanliness includes not only proper hand washing, but also things like wearing clean clothing (i.e. lab coat), long hair tied back, and clean short nails. Cuts / abrasions should be covered with a plaster and / or glove. Do not work with an upper respiratory condition.
Hand washing –
A physician should wash their hands before and after each contact with a patient. Soap with an antibacterial agent is preferred and strongly recommended. Clean paper towels should be used to dry hands. When washing your hands, friction and running water are very important to help remove germs from the surface of 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 insertion. Needle shafts, especially longer needles, can be stabilized with a sterile cotton ball or sterile gauze. If the needle touches an object (ie pants, clothing, bed) or is dropped on the ground, the needle is considered contaminated and should not be used. All used alcohol swabs and needle packings should be discarded from the clean area. Suction cups that come into contact with the skin require sterilization or disinfection before each use.
Packaging –
All packaged needles should be checked for the sterilization expiration date. Any package that is wet, torn, or expired is no longer considered sterile.
Types of sterilization
1. Steam
2. Boil
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 is used in concentrations of 70% to 90%. Be careful about using iodine, as it can leave permanent stains on clothing. Isopropyl alcohol is also an effective antiseptic. Always keep the caps of alcohol bottles closed to keep the concentration at 100%. When wiping the skin, the cotton ball or swab should be applied to a flowable wipe. Do not pass the skin back and forth or in a circular motion. Alcohol should not be applied to mucous membranes or open wounds.
Needle removal
All needles must be disposed of in suitable sharps containers in accordance with Public Health Regulations. Alcohol swabs or cotton balls should be disposed of in the trash unless they are completely soaked in blood.
Iatrogenic complications
1. Forgotten needle: There have been cases where a doctor has forgotten to remove a needle. Doctors should try to keep a needle count. This can reduce the risk of needles being forgotten. A forgotten needle could cause possible damage or injury.
2. Broken Needle – Very thin needles (> 34 gauge) are more susceptible to breakage during insertion. A broken needle with the shaft visible above the skin can be safely removed with a sterile forceps, but if the needle has broken and is below the surface of the skin, a medical referral will be necessary.
3. Blocked or stuck needle: The blocked or stuck needle can be the result of muscle spasms or if the patient moves. The result is 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 electroacupunctoscope and allow the patient to rest. Gently massage the area or meridian of the stuck needle to help loosen the needle. If the jammed needle is the result of patient movement, the patient should assume the original position and then the needle can be removed.
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 escape 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 to use the correct depth and angle of the needle.
Blood vessel
Puncture of small superficial veins is not uncommon. When this occurs, pressure should be applied to the affected site for about a minute. The doctor should always inform the patient of a bruise. Arterial puncture is more serious. You must apply firm pressure for about 3-5 minutes to bleed a small artery.
Organ puncture
All organs are susceptible to being punctured if they are punctured incorrectly. The organs that are most susceptible to being perforated are the bladder, kidneys, enlarged spleen or liver. And the peritoneal cavity. If one is puncturing lower abdominal points, how will the patient empty his bladder.
Spinal cord trauma
Loss of sensation or movement can result from a needle penetrating the spinal cord.
Neuritis
Inflammation of the nerve can result from punctured directly onto the nerves or from puncture with strong electrical stimulation. If the nerve is inflamed, the patient may experience numbness, electrical sensation, or motor weakness.
Infection
Allergic dermatitis
Signs and symptoms include redness of the skin, itching / burning sensation, and pain or discomfort at the insertion site. Acupuncture needles containing nickel and chromium are known to cause allergic dermatitis.
Various infections
Various infections that can occur include septicemia, osteomillitis, bacterial endocarditis, meningitis, and hepatitis. The only prevention methods for these conditions are the use of sterile needles and the identification of high-risk patients.
Other complications or side effects
1. Nausea: The patient may experience nausea if strong parasympathetic stimulation occurs during the puncture. Needles should be removed immediately if nausea or vomiting persists.
2. Normal Side Effects: You will often hear comments like “I feel dizzy” or “mild disorientation” or “euphoria”. These are all normal side effects of acupuncture. Sometimes the patient can also feel cold with prolonged retention of the needle (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 electroacupuncture.
When using the electroacupunctoscope, the current should never pass through the back or chest. The two branches of the same electrode must always be on the same side of the patient’s body. Electroacupuncture is contraindicated during pregnancy and in patients with any type of cardiac pacemaker.
The pregnancy
Traditional Chinese Medicine recommends not using needles during any normal asymptomatic pregnancy. If there are symptoms, puncture specifically toward the symptom is allowed.
Electrical stimulation and acupuncture
Waveform / frequency / intensity
Specifications for model AWQ-104E
• Pulse shape: biphasic rectangular wave
• Pulse width: 350 uS at X1, 40us at X10
• Pulse frequency (frequency): 1-120 Hz in X (1) 10-1200 Hz in X (10)
• Waveform: adjustable, dense scattered, intermittent
• Output current (intensity): 0-18mA (Lo) 0-40mA (Hi)
• Channel 4
• Point detector
Driving
• Be sure to examine the electroacupunctoscope before each use.
• Insert the needle (with metal handle) and get the feeling of Qi
• Make sure all knobs are set to zero before hooking the electroacupunctoscope to the needles.
• Connect the electrical stimulator with needles.
• Turn on the power.
• Adjust the electroacupunctoscope to the proper waveforms and frequency
• Adjust the intensity to a comfortable level.
• If it is necessary to change the “Hi-Lo” intensity switch or the “1-10” frequency switch, or the polarity, the output current (and frequency at some point) should be reduced to zero.
• The treatment should last between 15 and 20 minutes
• Make sure all knobs are zeroed before turning off the power and remove the lead wire.
Notes:
• 2 complete circuit needles
• Connect the negative end to the primary point, the positive end to the secondary point
Waveforms
Dense wave (continuous)
High frequency: 50-100 pulses per second
Function and indications:
Inhibits sensory and motor nerves.
Relieves pain, calms the mind, relieves spasms of muscles.
Scattered / sparse wave (continuous)
Low frequency: 2-5 pulses per second
Function: induce muscle contraction and improve muscle and ligament tension.
Indication: muscle, ligament and joint injury.
Dense-scattered wave
The stray wave and the dense wave appear alternately, each lasting approximately 1.5 s. Prevent the adaptation of the body.
Function:
Relieve pain, improve organ function, improve qi and blood circulation, improve tissue nutrition, reduce inflammation
Indication: Pain, trauma, sprain, arthritis, sciatica, facial paralysis, muscle weakness, etc.
Intermittent wave
A wave appears and fades rhythmically. Interval: 1.5 s
Function: stimulate muscles
Indication: paralysis.
Precautions / Contraindications
• Increase the intensity of the electroacupuntcope gradually to avoid incidents such as muscle contraction, broken needle and bent needle due to increased intensity.
• The number one priority is to keep the patient comfortable at all times.
• Mild stimulation is required when electroacupuncture is applied near the spine and brainstem.
• When applying electroacupuncture to the chest and back area in the heart region, do not connect points on two sides of the body to prevent current from passing through the heart.
• Do not apply stimulation to the region of the heart.
• Do not stimulate patients with pacemakers or other electronic implants.
• Use electroacupuncture with caution in patients with heart disease, seizures, and pregnant women.
• Electroacupuncture should be used with caution in elderly or weak patients.
Disease treatment
Advantage
1. Best for nerve-related problems
2. Stimulation is more measurable than manual
3. Many points can be stimulated at the same time (the manual can stimulate only one at a time)
4. Stimulation may last longer. A typical treatment is usually 20 minutes. If you are stimulating manually, you will normally only do it for a couple of minutes at the most.
• Points are selected in pairs
• Usually unilaterally
(Pair on the same left or right side Do not cross from one side to the other as this can interfere with the action of the heart)
