PRECAUTIONS, CONTRAINDICATIONS AND MANAGEMENT OF POSSIBLE ACCIDENTS

Precautions and Contraindications in Acupuncture Treatment

• It is advisable to apply few needles or to delay giving acupuncture treatment to the patients who are either famished or overeaten, intoxicated, over fatigued or very weak.
• It is contraindicated to puncture points on the lower abdomen and lumbosacral region for women pregnant under three months. After three months pregnancy it is contraindicated to needle the points on the upper abdomen and lumbosacral region, and those points causing strong sensation such as LI4, Sp6, B60 and B67.
• Points on the vertex of infants should not be needled when the fontanel is not closed. In addition, retaining of needles is forbidden since the infants are unable to cooperate with the practitioner.
• Needling should avoid the blood vessels to prevent bleeding. Points of the chest and back should be carefully needled to avoid injury of the vital organs. In Chapter 16 of Plain Questions, it says, " If you puncture the points at the chest and abdominal region, you should avoid hurting the five zang organs. "
• Historic medical literature of the past contraindicates certain points on the human body for puncture or deep puncture. Most of these points are located close to the vital organs or large blood vessels, such as S1 located below the eyeball, Ren15 near the important viscera, Sp11 near the femoral artery, etc. These points should generally be punctured obliquely or horizontally to avoid accidents

Management of Possible Accidents

Although acupuncture is safe and free from side - effects, some accidents may take place owing to negligence of the contraindications, imperfect manipulations, or want of the knowledge of anatomy. If an accident really occurs, the practitioner should keep calm. As long as he solves the problem in time, serious consequences can be avoided. The possible accidents are seen as follows :

Fainting

• Cause : This is often due to nervous tension, delicate constitution, hunger, fatigue, improper position or to the too forceful manipulation.
• Manifestations : During acupuncture treatment, there may appear dizziness, vertigo, palpitation, short breath, fidgets, nausea, pallor, cold sweating, weak pulse. In severe cases, there may be cold extremities, drop of blood pressure, and loss of consciousness.
• Management : When fainting aura such as dizziness, vertigo, fidgets and nausea appear, stop needling immediately and withdraw all the needles. Then help the patient to lie down, and offer him some warm or sweet water. The symptoms will disappear after a short rest. In severe cases, in addition to the above management, press hard with the fingernail or needle Du26, P9, Du25, P6 and S36, or apply moxibustion to Du20, Ren6 and Ren4. Generally, the patient will respond, but if not, other emergency measures should be taken.

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.
• Manifestations : After the needle is inserted, it is found at times difficult or impossible to rotate, lift and thrust the needles. This situation is known as stuck needle.
• Management : 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, 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.
• 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.

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.
• Manifestations : It is difficult to lift, thrust, rotate and withdraw the needle. At the same time, the patient feels pain.
• Management : When the needle is bent, lifting, thrusting, and rotating shall in no case be applied. The needle may be removed slowly and withdrawn 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 muscle and then remove the needle. Never try to withdraw the needle with force.
• 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. The needling area shall in no case be impacted or pressed by an external force.

Broken needle

• Cause : This may arise from the poor quality of the needle or eroded base of the needle, from too strong manipulation of the needle, from strong muscle spasm, or a sudden movement of the patient when the needle is in place, or from withdrawing a stuck needle.
• Manifestations : The needle body is broken during manipulation and the broken part is below the skin surface.
• 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 with forceps. If it is completely under the skin, surgery should be resorted to.
• Prevention : To prevent accidents, careful inspection of the quality of the needle should be made prior to the treatment to reject the needles which are not in conformity with the requirements specified. 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.

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
• 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

After - effect

• Cause : It is mostly due to the unskilled manipulation and forceful stimulation
• Manifestations : After withdrawal of the needle, there may remain an uncomfortable feeling of soreness and pain, which may persist for a long period
• Management : For the mild cases, press the local area, and for severe cases, in addition to pressing, moxibustion is applied to the local area
• Prevention : Too forceful manipulation shall in no case be applied