Safety Precautions in Acupuncture
Just recently, I was told by a colleague the story of how a so-called “practitioner” who just finished a few weekends’ worth of acupuncture courses faced a problem he/she could not handle. Apparently her patient grew lightheaded and nauseated after puncture and stimulation of Hegu LI4. Now, this is not typical but also not unexpected.
What was unexpected was that the so-called practitioner had no idea how to handle the situation.
This comes from inadequate training, and such phenomena are the subject of this article:
Int J Risk Saf Med. 2012 Jan 1;24(3):163-9. doi: 10.3233/JRS-2012-0569. Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency. Wheway J, Agbabiaka TB, Ernst E.
Patient Safety Division, National Patient Safety Agency, London, UK.
Acupuncture is frequently employed to treat chronic pain syndromes or other chronic conditions. Nevertheless, there is a growing literature on adverse events (AEs) from treatments including pneumothorax, cardiac tamponade and spinal cord injury. Acupuncture is provided in almost all NHS pain clinics and by an increasing number of GP’s and physiotherapists. Considering acupuncture’s popularity, its safety has become an important public health issue.
To evaluate the harm caused to patients through acupuncture treatments within NHS organisations.
The National Reporting and Learning System (NRLS) database was searched for incidents reported from 1st January 2009 to 31st December 2011. The free text fields of all reports received from all healthcare settings and specialties were searched for the keyword ‘acupuncture’. All relevant incidents were reviewed to provide a qualitative theme of the harm to patients. Results: 468 patient safety incidents were identified; 325 met our inclusion criteria for analysis. Adverse events reported include retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), Bruising or soreness at needle site (2%), Pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorised as low or no harm.
A number of AEs are recorded after acupuncture treatments in the NHS but the majority is not severe. However, miscategorisation and under-reporting may distort the overall picture. Acupuncture practitioners should be aware of, and be prepared to manage, any significant harm from treatments.
Let’s look at these more common adverse effects.
Retained needles: this means that after insertion, the patient was sent home with needles that the acupuncturist forgot to take out. This can be prevented with what I call a needle count. Quite simply, a practitioner records how many needles were put in as he puts them in, then after removing, does a count not unlike operative sponge counts during major operations.
Dizziness and loss of consciousness: I find that this is related to people usually being hungry at the time of treatment. During acupuncture treatment, the patient’s discomfort is exacerbated. The first aid for this would be to have candy or sugar water available to rapidly increase the blood glucose levels. Chocolate helps as well. To help get blood into the brain, we can also lie the patient flat and then prop the patient’s feet on a pillow to let gravity bring more blood to the head.
Falls: uh… proper positioning? This I think happens when a patient falls asleep and rolls off.
Soreness and bruising: Soreness is part of the treatment, but sometimes the feeling is retained after needle removal. Bruising is due to nicking of nearby blood vessels. Both can be prevented or alleviated by applying slight pressure with a sterile cotton ball.
Noteworthy here is the lack of infection. While this may be included in the uncategorized part, it is more likely due to the fact that most acupuncturists are trained in Clean Needle Technique, which should minimize any exposure to infection causing pathogens.
While unofficial, I also recommend that patients refrain from exposure to cold (whether environmental or food or drink) for about 2-3 hours after an acupuncture treatment. Experience has shown that exposure to such may cause cramps.
Stay happy and healthy!