Clean Needle Technique - CCAOM

1 Clean Needle TechniqueManualBest Practices for AcupunctureNeedle Safetyand Related Procedures7th EditionPubl ishe d by t he Counc il of Col lege s of Acupunc tur e and O rient al Medi cine 2015 CCAOM Clean Needle Technique Manual 7th EditionBest Practices for Acupuncture Needle Safety and Related Procedures Seventh EditionRevised January 2016 Council of Colleges of Acupuncture and Oriental Medicine 2015 by the Council of Colleges of Acupuncture and Oriental Medicine. Reviewed and updated January 11, 2016. All rights reserved, including the right to reproduce this work in any form whatsoever, without permission in writing from the publisher, except for brief passages in connection with a review. Printed in the United States of America ISBN 978-0-9963651-0-9 Editor: Jennifer Brett, , Cover Design: Roberta McGrew Cover Photos: Leaf , Nanette Grebe The Clean Needle Technique (CNT) Manual is intended for use primarily by state-licensed acupuncturists and students enrolled in a formal course of instruction at a school approved by the Accreditation Commission for Acupuncture and Oriental Medicine.

2 As a statement of best practices concerning acupuncture needling and related techniques, the manual may also be beneficially used by state-licensed healthcare professionals in other disciplines who have acupuncture and related modalities within their lawful scope of practice and by acupuncturists outside the United States who are appropriately authorized to practice acupuncture within their respective national jurisdictions. The manual is not intended for use by persons without formal training and regulatory authorization to practice acupuncture. The manual focuses on safety and is not a guide to appropriate treatment for particular health conditions. While the manual is intended to reflect best practices as of the date of publication, opinions as to best practices may differ and change over time. Ongoing study and debate concerning best practices within the academic and practitioner communities is encouraged. The Council assumes no liability for any injury that may occur as a result of a practitioner's use of, or reliance upon, any safety protocol contained in this manual.

3 I Table of Contents Preface .. xiv Acknowledgements .. xvi Introduction .. xvii References .. xix Part I: AOM Clinical Procedures, Safety, Adverse Events (AEs) and Recommendations to Reduce AEs .. 1 References .. 2 1. Acupuncture .. 3 Safety/Adverse Events A Review of the Literature .. 3 Preventing Acupuncture Needling Adverse Events .. 4 Bruising and Bleeding .. 4 Safety Guidelines to Prevent Bruising, Bleeding, and Vascular Injury .. 5 Needle Site Pain/Sensation .. 5 Safety Guidelines to Prevent Needle Site Pain .. 6 Fainting .. 7 Safety Guidelines to Prevent Fainting .. 7 Stuck Needle .. 7 Safety Guidelines to Avoid and/or Respond to Stuck Needle .. 8 Failure to Remove Needles .. 8 Safety Guidelines for Needle Removal .. 9 Aggravation of Symptoms .. 9 Safety Guidelines for Aggravation of Symptoms .. 10 Preventing Rare but Serious Adverse Events (SAEs) Associated with Acupuncture Needling .. 10 Pneumothorax .. 10 Safety Guidelines to Avoid Pneumothorax.

4 12 Injury to Other Organs .. 13 Central Nervous System Injury .. 15 Safety Guidelines to Avoid Organ and Central Nervous System Injury .. 15 Traumatic Tissue Injury .. 15 Peripheral Nerves .. 15 ii Blood Vessels .. 16 Safety Guidelines to Avoid Traumatic Tissue Injury .. 16 Infections .. 16 Safety Guidelines to Prevent Infection .. 17 Broken Needle .. 18 Safety Guidelines to Prevent Broken Needles .. 19 References .. 19 2. Moxibustion .. 24 Safety/Adverse Events A Review of the Literature .. 24 Preventing Moxibustion Adverse Events .. 25 Burns .. 25 Safety Guidelines to Prevent Moxa Burns .. 26 Secondary Infection from Moxa Burns .. 26 Safety Guidelines to Prevent Secondary Infection from Moxa Burns .. 27 Nausea or Other Adverse Reactions to Moxa Smoke .. 27 Safety Guidelines to Prevent Adverse Reactions to Moxa Smoke .. 27 Other Heat Therapies .. 27 Safety Guidelines for Heat Therapies Other than Moxa .. 28 References .. 29 3. Cupping.

5 31 Safety/Adverse Events A Review of the Literature .. 31 Fire Cupping .. 31 Suction Cupping .. 32 Wet Cupping .. 32 Other Cupping Procedures .. 32 Cupping Adverse Events .. 32 Skin Reactions .. 32 Cardiovascular .. 33 Infections .. 34 Preventing Cupping Adverse Events .. 35 Burns .. 35 Safety Guidelines to Avoid Fire Cupping Burns .. 35 iii Infections .. 35 Safety Guidelines to Prevent Cupping-Related Infections .. 36 Standards for Reuse of Cupping Devices .. 36 Cleaning and Disinfecting Cups .. 37 Safety Guidelines for Cup Disinfection .. 38 Extensive Bruising & Other Skin Lesions .. 39 Safety Guidelines for Preventing Cupping Skin Lesions .. 39 Unintended Deep Penetration of the Needle .. 39 Safety Guidelines for Needle Cupping .. 40 Safety Guidelines to Prevent Cupping Adverse Events .. 40 References .. 40 4. Electroacupuncture (EA) .. 43 Safety/Adverse Events A Review of the Literature .. 43 Excessive Current .. 44 Anatomical Considerations.

6 44 Preventing EA Adverse Events .. 45 Safety Guidelines for Preventing EA Adverse Events .. 45 Injuries Due to Muscle Contraction .. 45 Safety Guidelines for Preventing Excessive Muscle Contraction During EA .. 45 Electrical Injury .. 46 Safety Guidelines for Preventing Electrical Injury During EA .. 46 Interference with a Cardiac Pacemaker .. 46 Safety Guidelines for Preventing Interference with a Cardiac Pacemaker During EA .. 46 References .. 46 5. Therapeutic Blood Withdrawal .. 48 Safety/Adverse Events A Review of the Literature .. 48 Preventing Acupuncture Bleeding Therapy Adverse Effects .. 49 Safety Guidelines for Acupuncture Bleeding Therapy .. 50 References .. 50 6. Gua Sha .. 52 Safety/Adverse Events A Review of the Literature .. 52 Preventing Gua Sha Adverse Events .. 53 iv Safety Guidelines for Gua Sha .. 53 Disinfection of Gua Sha Devices .. 54 Safety Guidelines for Disinfection of Gua Sha Tools .. 55 References .. 55 7.

7 Plum Blossom Needling .. 57 Safety/Adverse Events A Review of the Literature .. 57 Preventing Plum Blossom Needling Adverse Events .. 57 Safety Guidelines for Plum Blossom (Seven Star) Therapy .. 57 References .. 58 8. Press Tacks and Intradermal Needles .. 59 Safety/Adverse Events A Review of the Literature .. 59 Auricular Therapy/Press Tacks .. 59 Intradermal Needling .. 59 Safety Guidelines for the Use of Press Tacks or Intradermal Needling .. 60 References .. 61 9. Ear Seeds .. 63 Safety/Adverse Events A Review of the Literature .. 63 Preventing Ear Seed Adverse Events .. 63 Safety Guidelines for the Use of Ear Seeds .. 63 References .. 63 10. Tui Na .. 64 Safety/Adverse Events A Review of the Literature .. 64 Preventing Tui Na Adverse Events .. 65 Safety Guidelines for Tui Na .. 65 References .. 65 11. Other Acupuncture-Related Tools .. 67 Manaka/Japanese Acupuncture Tools .. 67 A Review of the Literature .. 67 Preventing Adverse Events.

8 67 Shonishin Pediatric Japanese Acupuncture Tools .. 67 A Review of the Literature .. 67 Preventing Common Adverse Events .. 67 v Part II: Best Practices for Acupuncture - CNT .. 68 1. CNT Protocol .. 68 Hand Sanitation .. 69 Safety Guidelines for Hand Sanitation .. 69 Preparing and Maintaining a Clean Field .. 70 Safety Guidelines for Preparing and Maintaining a Clean Field .. 70 Skin Preparation .. 71 Alcohol Swab Method .. 72 Safety Guidelines for Skin Preparation .. 73 Isolation of Used Sharps .. 73 Standard Precautions .. 74 Basic Steps of the Clean Needle Technique for Acupuncture .. 74 2. CNT Basic Principles .. 76 Setting Up the Clean Field .. 77 Inspecting Needle Packaging Prior to Use .. 78 Skin Preparation .. 78 Palpating the Point .. 78 Inserting Needle to Correct Depth .. 79 Needle Removal .. 80 Dealing with Blood to Blood Contact .. 80 Managing Used Needles .. 80 Counting Needles .. 81 3. CNT in an Office Setting .. 82 Treatment Protocol in an Office Setting.

9 82 4. CNT for House Calls/Travel Setting .. 84 Travel Kit /Travel Kit Carrier .. 84 Clean Items .. 84 Non- Clean Items .. 85 Travel Kit Items Not in Bags .. 85 Hand Cleanser .. 86 Travel Sharps Container .. 86 Preparing the Kit .. 86 vi Treatment Protocol in a Travel Setting .. 86 5. CNT in a Community Acupuncture Clinic or NADA Setting .. 89 Treatment Protocol in a Community Clinic or NADA Setting .. 89 6. CNT in a Public Health Setting .. 91 Handwashing .. 91 Acupuncture Equipment .. 92 Positioning the Patient .. 92 Removing Needles .. 92 Potential Complications .. 93 7. Toyohari Acupuncture .. 94 Modifications to Standard Clean Needle Technique for Contact Needling .. 94 8. Summary of Safety Recommendations for Clean Needle Technique .. 95 References .. 98 Part III: Best Practices for Related AOM Office Procedures .. 101 1. Moxibustion .. 102 Moxibustion Overview .. 102 General Moxibustion Precautions .. 103 Moxa Best Practice Guidelines.

10 104 Direct Moxibustion - Technique for Non-Scarring Moxibustion with Moxa Cones .. 104 Method .. 104 Safety Considerations .. 105 Direct Moxibustion - Technique for Scarring Moxibustion with Moxa Cones .. 105 Method .. 105 Safety Considerations .. 106 Indirect Moxibustion Technique with Interposed Moxibustion .. 107 Method .. 107 Safety Considerations .. 108 Indirect Moxibustion - Warming Needle Moxibustion .. 108 Method .. 108 Safety Considerations .. 109 Indirect Moxa Technique with Moxa Stick .. 110 Method .. 110 vii Safety Considerations .. 110 Moxa Disposal .. 111 2. Heat Lamps .. 112 Best Practice Protocols for Heat Lamps .. 112 Method .. 112 Safety Considerations .. 112 3. Cupping .. 114 Cupping Overview .. 114 General Recommendations for Cupping .. 114 Sample Best Practice Protocols for Cupping .. 115 Fire Cupping Method .. 116 Safety Considerations .. 116 Suction Cupping .. 117 Method .. 117 Wet Cupping .. 117 Method .. 118 4.