clean needle technique
Infection Control – Physician Hygiene
Physical cleanliness includes not only proper handwashing, but also includes such things as wearing clean clothing (ie, lab coat), keeping long hair pulled back, and keeping fingernails clean and short. Cuts/abrasions should be covered with a Band-Aid and/or glove. Do not work with an upper respiratory condition.
Hand washing –
A doctor should wash their hands before and after each contact with the patient. A 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 surface germs from the epidermal layer of your 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 pad. If the needle touches any object (eg, pants, clothing, bed) or if it falls on the floor, the needle is considered contaminated and should not be used. All used alcohol swabs and needle packaging should be disposed of from the clean area. Cupping that comes into contact with the skin requires sterilization or disinfection before 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 is used in concentrations of 70% to 90%. Be careful about using iodine as it can leave permanent stains on your clothes. Isopropyl alcohol is also an effective antiseptic. Always keep alcohol bottle caps closed to maintain 100% concentration. When swiping the skin, the cotton ball or swab should be applied to a liquid wipe. Do not slide the skin in circular or back-and-forth motions. Alcohol should not be applied to mucous membranes or open wounds.
needle disposal
All needles must be disposed of in appropriate 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. Physicians should try to keep a needle count. This can reduce the risk of forgotten needles. A forgotten needle could cause possible damage/injury.
2. Broken needle: Very fine needles (>34 gauge) are more likely to break during insertion. A broken needle with the shaft visible above the skin can be safely removed with sterile forceps, but if a needle has broken and is below the surface of the skin, a medical referral will be necessary.
3. Blocked or stuck needle: A 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 goes into spasm and locks the needle in place. When this occurs, the needle should never be forcibly withdrawn. You should stop the electroacupunctoscope and allow the patient to rest. Gently massage the stuck needle area or meridian to help loosen the needle. If the stuck 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 the use of 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 hematoma. Arterial puncture is more serious. You need to apply firm pressure for about 3-5 minutes for bleeding from a small artery.
organ puncture
All organs are susceptible to being punctured if punctured incorrectly. The organs that are most likely to be perforated are the bladder, the kidneys, the enlarged spleen or the liver. and the peritoneal cavity. If one needs lower abdominal points, like the patient to empty their bladder.
spinal cord trauma
Loss of feeling or movement can result from a needle penetrating the spinal cord.
neuritis
Nerve inflammation can result from puncturing directly over the nerves or from puncturing 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 skin redness, itching/burning sensation, and pain or discomfort at the insertion site. Acupuncture needles containing nickel and chromium are known to cause allergic dermatitis.
miscellaneous infections
Miscellaneous infections that can occur include septicemia, osteomylitis, 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 “high”. These are all normal side effects of acupuncture. Occasionally, the patient may 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 on 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 those patients with any type of cardiac pacemaker.
The pregnancy
Traditional Chinese Medicine recommends no need during any normal asymptomatic pregnancy. If there are symptoms, the specific need for the symptom is allowed.
Electrical stimulation and acupuncture
Waveform/Frequency/Intensity
Specifications for model AWQ-104E
• Pulse shape: biphasic rectangular wave
• Pulse width: 350us at X1, 40us at X10
• Pulse rate (frequency): 1-120 Hz at X(1) 10-1200 Hz at X(10)
• Waveform: adjustable, dense-sparse, 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 at zero before attaching the electroacupunctoscope to the needles.
• Connect the electrical stimulator with needles.
• Turn on the power.
• Set the electroacupunctoscope to the appropriate waveforms and frequency.
• Adjust the intensity to a comfortable level.
• If it is necessary to change the intensity switch “Hi-Lo”, or the frequency switch “1-10”, or the polarity, the output current (and at some point the frequency) must be reduced to zero.
• The treatment should last 15-20min
• Make sure all knobs are at zero before turning power off and remove lead wire.
Grades:
• 2 needles complete with circuit
• Connect the negative end to the main point, the positive end to the secondary point
waveforms
Dense wave (continuous)
High frequency: 50-100 pulses per second
Function and indications:
It inhibits sensory nerves and motor nerves.
Relieves pain, calms the mind, relieves spasm of muscles
Sparse/Scant Wave (Continuous)
Low frequency: 2-5 pulses per second
Function: Induce muscle contraction and improve muscle and ligament tension.
Indication: muscle, ligament and joint injuries.
Dense-sparse wave
Scattered wave and dense wave appear alternately, each lasting about 1.5s. Prevent the adaptation of the body.
Function:
Relieves pain, improves organ function, improves qi and blood circulation, improves tissue nutrition, reduces inflammation
Indication: Pain, trauma, sprain, arthritis, sciatica, facial paralysis, muscle weakness, etc.
intermittent waves
A wave appears intermittently rhythmically. Interval: 1.5s
Function: stimulate muscles
Indication: Paralysis.
Precautions/Contraindications
• Gradually increase the intensity of the electroacupointoscope to avoid incidents such as muscle spasms, needle breakage and twisted needle due to increased intensity.
• The number one priority is to keep the patient comfortable at all times.
• Mild stimulation is required when applying electroacupuncture near the spine and brainstem.
• When applying electroacupuncture to the chest and back area in the heart region, do not connect points on both sides of the body to prevent the current from passing through the heart.
• Do not apply stimulation to the heart region.
• Do not apply stimulation to 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 frail patients.
disease treatment
Advantage
1. Best for nerve-related problems
2. Stimulation is more measurable than manual stimulation
3. Many points can be stimulated at the same time (manual can only stimulate one at a time)
4. The pacemaker can last longer. A typical treatment is usually 20 minutes. If you are stimulating manually, it usually only stimulates for a couple of minutes at most.
• Points are selected in pairs
• Usually unilaterally
(Match from 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)