Acupuncture Guideline

Hong Kong Hospital Authority PTCOC

Operation Guideline For Acupuncture by Physiotherapists

July 2009 Revision

Forward This revised operation guideline for acupuncture by physiotherapists was prepared by the Acupuncture Working Group# of PTCOC, Hong Kong Hospital Authority. The revision focuses on updates of infection control procedures for acupuncture practice by physiotherapists. This guideline was designed to be used as a guide to acupuncture practice by physiotherapists working in Hong Kong Hospital Authority. The content of this guideline was based on epidemiological and other research evidence available in international literature and guidelines, supplemented where necessary by the consensus opinion of the Acupuncture Working Group of PTCOC, Hong Kong Hospital Authority.

#

Composition of the Acupuncture Working Group, PTCOC:

Chairman Mr. Eric LAW Yuen Tung

SPT, POH

Secretary Ms. Cecilia KWOK Yee Fung

PTI, RHTSK

Members Mr. Andy CHAN Chi Ming Mr. Anthony LAU Wing Keung

SPT, HKBH DM(PT), AHNH

Mr. Alex WONG Kam Wah Mr. Chris WONG Hiu Po Mr. Frank LAU Wai Kwong Mr. Kenny YUEN Chi Chung Mr. Raymond TSANG Chi Chung

PTI, PYNEH PTI, TWH PTII, HHH PTI, DTRC SPT, QMH

Mr. Simon HUI Wai Chi Mr. Steward CHEUNG Ying Kit Mr. Tony CHIU Hiu Fai

SPT, KCH SPT, KWH PTI, UCH

Introduction Acupuncture has been embraced as one of the treatment modalities within the scope of Physiotherapy practice in some hospitals in Hong Kong since 1980’s. According to the Chinese Medicine Ordinance 108(3), the Hong Kong Government SAR has legitimized the practice of acupuncture, bearing distinguishable differences from that based on Traditional Chinese Medicine, by registered physiotherapists in Hong Kong. To uphold the standard of local physiotherapists practicing acupuncture , there is an accreditation procedure by our professional body – the Hong Kong Physiotherapy Association , which has set its standards in line with the international benchmark- the International Acupuncture Association of Physical Therapists (IAAPT). In response to the increasing demand on acupuncture by patients, acupuncture has been incorporated as one of the therapeutic interventions by local physiotherapists and their counterparts worldwide including United Kingdom, Canada and Australia. Thorough Physiotherapy Assessment, a procedure by which collection of relevant information and quantified data, is conducted prior to treatment. A problem list and physical diagnosis utilizing clinical reasoning process based on Western Medicine will then be formulated. Treatment modalities including acupuncture, targeted towards resolving the clinical problems, are explained and implemented to the patient. Parameters of acupuncture are selected based on quality medical literature protocols and good knowledge of human anatomy, neuroanatomy, neurophysiology in pain and motor control and related information on physiology and pathology of the conditions treated. All evaluative and therapeutic interventions should be documented according to the “Operation Guidelines for Physiotherapists Practicing Acupuncture in Hospital Authority.” In benchmarking with the international standard set by the International Acupuncture Association of Physical Therapists (IAAPT) under the World Confederation for Physical Therapy (WCPT), which is a member organization of the World Health Organization, this “Operation Guidelines for Physiotherapists Practicing Acupuncture in Hospital Authority” is formulated to progress and uphold the quality and standard of physiotherapy service to all patients in guarding their interest & benefit. All physiotherapists practicing acupuncture in Hospital Authority have to abide strictly the “Code of Practice” issued by the Physiotherapists Board of Hong Kong. To match with the pace of the rapid advancement of modern medicine and technology, these operation guidelines are subjected to review by the Central Coordinating Committee (Physiotherapy) of the Hospital Authority in line with the contemporary standards of the IAAPT and the Hong Kong Physiotherapy Association.

CONTENT 1.

Standards of Practice of Acupuncture by Physiotherapists in

p.5

Hospital Authority 2.

Formulation of Acupuncture Treatment Plan

p.6

3.

Contraindications and Precautions of Acupuncture

p.7-10

4.

Warnings given to patients prior to Acupuncture Treatment

p.11

5.

Acupuncture Infection Control Procedure

p.12-14

6.

Prevention of Needle Accidents & Adverse Reaction

p.15-18

7.

Management of Possible Complications

p.19-21

8.

Application of Electro-acupuncture (EA)

p.22-23

9.

Application of Auricular Acupuncture, Press Needle and Bead

p.24-25

10

Patient Information for Acupuncture

p.26

11

接受針刺治療病人須知

p.27

12.

Acupuncture Treatment Record Sheet

p.28

13.

Reference

p.29-31

Standards of Practice of Acupuncture by Physiotherapists in Hospital Authority

All registered physiotherapists who practice acupuncture should:1. Have successfully completed a training program in acupuncture AND be accredited by the Hong Kong Physiotherapy Association Ltd. 2. Confine their practice of acupuncture to the treatment of conditions within their scope of practice of physiotherapists in Hong Kong. 3. Apply acupuncture as one of the treatment modalities of the physiotherapy profession. 4. Facilitate exchange of information by using common codes and terminology, i.e. WHO nomenclature. 5. Maintain a high standard of documentation to describe acupuncture procedures, including explanation to patients, list of combination of points selected, method of manipulation, duration and frequency of application. 6. Comply with safe acupuncture practice by following recommendations in this guideline. 7. Comply with standards of infection control procedures as recommended in this guideline. 8. Follow the Code of Practice issued by the Physiotherapists Board of Hong Kong.

5

Formulation of Acupuncture Treatment Plan A.

Assessment 1. 2. 3.

Subjective and objective information from patients, as well as medical investigation, patient’s personal particulars are collected. Data from the assessment should be documented as clinical records. Data is analyzed.

4.

Area and type of acupuncture intervention are identified.

B. Intervention Plan 1. 2.

Goal for acupuncture intervention should be set. Problems, goals and intervention program (including acupuncture and other

3.

appropriate modalities) should be discussed with patients. Contra-indications and precautions for acupuncture and all intervention modalities selected should be noted. A checklist prior to implementation of

4. 5. 6.

acupuncture is advised. See Appendix I for reference. Verbal consent for acupuncture treatment must be obtained from patients. Intervention plan and time frame of therapy are designed. Acupuncture intervention plan, as aligned with the holistic treatment plan, is documented.

C.

Implementation of Acupuncture Treatment 1. 2. 3.

4.

All safety precautions are taken. Warning regarding inappropriate responses should be given to patients. Hygiene and sterilization procedures for both patients and therapists are followed. Standards of waste disposal and handling of blood and body fluid are followed.

5.

On going reassessments are needed and appropriate changes will be made if so required.

6.

Records describing acupuncture points, penetration depth, angle of insertion, acupuncture procedures, treatment dosage, and if any electro-acupuncture or special needle manipulation has been applied, are documented to facilitate communication with internal and external customers. Common codes in WHO nomenclature are used to enable exchange of information internationally. Appendix II is a recording form for reference.

6

Contra-indications and Precautions of Acupuncture A good knowledge of anatomy is essential in order to avoid structural damages such as nerves, organs or arteries.

A. Prohibited Areas for Needling The following areas should be avoided at all times. 1. Scalp area of infants before the fontanelle has closed 2. Nipples and breast tissues 3. Umbilicus 4. 5.

External genitalia Eye balls

B. General Precautions 1. 2.

Patients with uncontrolled movement are not suitable for acupuncture. Patients allergic to metals may not be suitable for acupuncture without medical clearance.

C. Special Precautions 1.

Dangerous or vulnerable points which may lead to damage Certain useful points which are potentially dangerous and therefore require special attention in their use. For example, these apply to: a.

Orbit of eye: B1 ( Jingming 睛明), medial orbit S1 ( Chengqi 承泣), mid-lower orbit Ex-HN4 (Yuyao 魚腰), mid-eyebrow

b.

Certain neck points: CV22 (Tiantu 天突), in front of trachea LI 18 (Futu 扶突), side of neck over great vessels SI 17 (Tianrong 天容), side of neck near baroreceptors GV 15 ( Yamen 啞門), over spinal cord GV 16 ( Fengfu 風府), over brain stem

7

c.

Points over lung tissues unprotected by bone or cartilage: L 1 (Zhongfu 中府), front of upper lung G 21 ( Jianjing 肩井), apex of lung B 11 ( Dazhu 大杼), back of upper lung Liv 14 ( Qimen 期門), anterior of lung

d.

Points over small nerves in the region of the elbow to fingers :SI 8 (Xiaohai 小海) H 3 (Shaohai 少海) H 7 (Shenmen 神門)

e.

Points near arteries :S 9 (Renying 人迎), near carotid artery in anterior neck S 12 (Quepen 缺盆), above clavicle in neck SP 11 (Jimen 箕門), near femoral artery at inner thigh SP12 (Chongmen 沖門), near femoral artery at groin region L 9 (Taiyuan 太淵), on radial artery at radial side of wrist

f.

g.

Point over gallbladder :Right S 21 (Liangmen 梁門), lies over gall bladder CV 17 (Ren 17, Danzhong 膻中), a small portion of population may have a hole in the sternum; SI 11 (Tianzong 天宗), a small portion of population may have a hole in the scapula

h.

Liv 3 (Taichong 太沖), hypertensive patients may suffer from a rapid drop of BP

i.

Ah Shi points close to vulnerable structures

j.

Avoid needling certain pathological sites e.g. varicose veins; inflammatory areas; malignant tumours; areas of unhealthy skin

k.

Avoid needling lower GV ( Governor Vessel ) Meridian points in the presence of Occult spinal bifida.

l.

Avoid needling deep and perpendicularly on points of the chest, hypochondria and spine. 8

2.

Pregnant patients-Avoid acupuncture in the first trimester of pregnancy as needling may cause a “miscarriage”, or in the last 3 months as it may cause premature labour. Also to avoid points that are considered especially likely to disturb a pregnancy. e.g. a. LI 4 (Hegu 合谷) SP 6 (Sanyinjiao 三陰交) K 3 ( Taixi 太溪) B 60 (Kunlun 昆侖) B 67 (Zhiyin 至陰) b.

points over lower abdomen

c. d. e.

ear points related to endocrine and genito-urinary system scalp points for genital and motor sensory areas strong electro-stimulation to acupuncture points.

3.

Diabetics patients- Care should be taken when needling diabetic patients because of the danger of poor peripheral circulation and the effect of some points on blood sugar level.

4.

Frail Patients- Patients with a weak constitution after prolonged chronic illness may tolerate acupuncture poorly.

5.

Strong manipulation is not recommended.

Active/Powered-Implant Patients- Patients with active/powered implants such as : cardiac pacemakers/defibrillators, stimulation/sensing electrodes, implantable drug pumps and neurostimulators, should not be given electro-acupuncture.

6.

Confused Patients- Great care must be taken with patients who are unable to understand the acupuncture procedure.

7.

Children- Parental consent must be obtained for treatment of children.

8.

Bleeding disorders:a. naturally occurring b. c.

9.

haemorrhagic

diseases

like

haemophilia,

Von

Willebrands drug-induced bleeding, like warfarin apply pressure on each point on removing needles

Drugs- Patients receiving drug treatment for certain diseases may suffer complications due to over-correcting of that condition by the homeostatic action acupuncture eg. patients with high blood pressure or diabetes. 9

10. When Sensation of acupuncture cannot be obtained at a conservative needle depth, let the needle rest and allow Sensation of acupuncture to come to the needle over time. 11. Acupuncture should not be inserted in a limb with lymphoedematous swelling. Broken skin is a source of potential infection and cellulitis, and the patient could continue to ooze fluid from the sites of needle insertion.

10

Warnings Given to Patients Prior to Acupuncture Treatment 1.

In the process of acupuncture treatment, there may be a very mild pain/discomfort during insertion of needles.

2.

The normal sensation during the retention of needles is soreness, heaviness / fullness, local/ radiating paraesthesia and/ or warmth.

3.

Do not move or contract muscles over the treatment areas.

4.

Do not fall asleep.

11

Acupuncture Infection Control Procedure A. Practitioner Preparation 1.

Practitioners should wash hands with liquid soap and water, and thoroughly pat dry hands before and after acupuncture application to patients.

2.

Any cut/breaks in skin should be covered with water-proof dressing or sterile disposable glove worn.

3.

Immediately before needle insertion, practitioner should wipe their hands again with approved disinfectant hand-rub such as those containing 70%-80% w/w ethanol.

B. Patients’ skin preparation B.1 For patients with normal immune system 1.

The patient’s skin should be clean and free from cut, wound and infection.

2.

The patients’skin should be inspected for dirt and grease. If skin is dirty, oily or sweaty, it should be washed with warm water and liquid soap, rinsed and dried before a skin disinfectant is applied. Dirty skin may inactivate the skin disinfectant.

3.

The needling site must be disinfected prior to acupuncture using disinfectant such as 70-80% ethanol, 60-70% isopropanol, 0.5-1% w/v chlorhexidine or povidone-iodine. [Note: all practitioners must check for iodine allergy if using disinfectant containing iodine.]

4.

Individual pre-packaged sterile disinfectant wipes such as alcohol wipes are recommended.

5.

Disinfectant should be left on the patient’s skin for acupuncture for at least 1 minutes and then allowed to dry, before commencing acupuncture. The patient’s skin should not be touched after skin disinfection. 12

B.2 For patients with deficiency in immune system or when needling into a joint space 5.

For patients who have a deficiency in their immune systems, or when needling into a joint space, a disinfectant such as povidone iodine or 0.5-1.0 % w/v chlorhexidine in alcohol should be used. The disinfectant should be left on the skin for a minimum time of 1 minute and then allowed to dry. [Note: all practitioners must check for iodine allergy. For those patients allergic to iodine, chlorhexidine in alcohol is suitable as a substitute.]

C. Needle Insertion 1.

Sterile, single-use, disposable acupuncture needles with guide-tubes are recommended.

2.

Ensure the portion of the needle to penetrate the skin does not come into contact with the bare fingers of the practitioner, or any non-sterile surface.

3.

The number of needles inserted must be documented

D. Needle Manipulation 1.

Manipulate needle using the handle of the needle. Avoid touching the shaft of the needle.

2.

In the case of long needles, a sterile glove may be used to grasp the top of the needle shafts for insertion and/or manipulation.

E. Needle Removal 1.

Practitioners must wash their hands with liquid soap and water and dry hands. Use of approved disinfectant hand-rub is an alternative for hand hygiene if the hands are not soiled and are clean.

2.

Withdraw needle by grasping needle handle, using a sterile, dry swab/cotton wool ball to apply pressure to the insertion point to prevent bleeding.

13

3.

Used needles and swab/cotton wool balls must be disposed into an approved sharps disposal container immediately.

4.

It is important to document the number of the needles removed and check against the number of needles inserted.

5.

Therapists should thoroughly wash their hands with liquid soap and water or rub their hands in approved disinfectant hand-rub at the end of the treatment as a routine infection control procedure to reduce the risk of cross-infection.

F. The Environment 1.

The treatment area should be clean and with washing facilities near at hand.

2.

Wet surfaces must be disinfected regularly.

3.

Linen contaminated with blood and other body fluids should be treated with hypochlorite solution before laundering.

G. Handling of Blood and Body Fluid 1.

Care must be taken to avoid contact with patients’ blood and body fluid. Should bleeding occur, a dry cotton wool ball should be used to absorb it. The used cotton wool ball should be put into an appropriate container marked ‘Contaminated Material’ and disposed of according to the Hospital Authority policy and guideline.

14

Prevention of needle accidents & adverse reactions Possible Needle Accidents or Adverse Reactions

Possible causes

1.Structural Injury
including puncture to vital structures


2. Pain during needle insertion

3. Pain after needle Insertion

Recommended Preventive Measures

Unskillful needle
insertion and



manipulation Excessive stimulation / manipulation




Good knowledge in body anatomy Point palpation prior to needle insertion Skillful needle insertion and appropriate manipulation Avoid puncture blood vessels, nerves and internal organs by altering the





direction and depth of needle insertion Selection of alternative points Using appropriate needles




Blunt, hooked or thick needles





Check needle before needle insertion Use quality needles




Highly sensitive patients





Use needle of appropriate size Full explanation and assurance to patient prior to treatment




Needle entwined
with fibrous tissue
during manipulation
Needle curves




Avoid excessive manipulation Treat in a comfortable, relaxed and supported position Instruct patient not to move during treatment

while patient moves 4. Pain after needle withdraw








Excessive stimulation

15

Avoid excessive/ prolonged Stimulation

Possible Needle Accidents & Adverse Reactions 5. Formation of

Possible Causes




haematoma after treatment

6. Fainting during / after treatment










7. Stuck needle

Excessive




Avoid puncturing blood vessels

manipulation/ stimulation




Press puncture site immediately after the needle is withdrawn with a sterilized dry cotton wool ball/ cotton bud.

Nervous apprehension Tiredness Hunger General weakness Severe diarrhea After profuse






Full explanation before treatment Treat in a comfortable and relaxed position Minimize the number of needles




especially in the first treatment session Avoid acupuncture for patients

sweating Excessive stimulation with needles




Muscle spasm




Change of position after needle insertion Entanglement of




needle in fibrous tissue during manual




Recommended Preventive Measures

stimulation / improper manipulation Prolonged retention of needle

16




with fatigue, severe thirst and hunger Avoid acupuncture for frail patients / unstable medical




condition Use gentle stimulation especially in the first treatment session




Treat in a comfortable , relaxed and





supported position Avoid puncture muscle tendons Proper manipulation Avoid unnecessary retention of needle

Possible Needle Accidents or Adverse Reactions 8. Bent needle

Possible causes











Too forceful or rapid manipulation

Recommended Preventive Measures




Skilled needle manipulation




Good knowledge in body

Needle strike hard tissues
Sudden change of posture after


anatomy Treat in a comfortable , relaxed and supported position Instruct patient not to move

needle insertion


during treatment Needling area should be protected from external force





Use quality needles Check needle before use

Collision of needle handle with external force

9. Broken needle`

10. Drowsiness




Poor needle quality




Sudden change of
Do not insert needle fully up to patient posture shaft / handle junction
Treat in a comfortable , relaxed and supported position


Instruct patient not to move during treatment




Prolonged




Minimize the number of needles







retention of needles Excessive

Avoid prolonged retention of needles Minimize stimulation




stimulation

17

Possible Needle Accidents or Adverse Reactions 11. Needle stick` Injury

Possible Causes


Improper management needle

Recommended Preventive Measures


of






Use needle guide to facilitate needle insertion Count number of needles after insertion and on removal of needles Use a gloved hand to hold the cotton ball or use a cotton bud to assist to remove the needles All used needles should be directly discarded in a sharps container clearly marked "danger- contaminated needles"







18

Locate sharps containers in close proximity to treatment table, and secure them to a wall or horizontal surface. Replace sharps containers when they are more than 2/3 full.

Management of Possible Complications Possible complications

Suggested Management

1.

Pain caused by needle inserted deep into tissues and hitting pain receptor nerve fibers




Adjust the depth and direction of needle insertion

2.

Pain caused by needle entwined with fibrous tissue during manipulation




Gently rotate the needle back and forth until the fiber is released

3.

Pain caused by curved needle after the
patient moved

Resume the original position , then withdraw the needle carefully

4.

Pain caused by unskilled manipulation


Massage the affected area gently with clean

or excessive stimulation

gauze for a while after withdrawal of needle

5.

6.

Mild Haematoma

Large Haematoma





Haematoma may resolve by itself. Reassure patient.




Detail documentation on location and size of haematoma.




Apply a cold compression to stop bleeding. Then after the acute phase, apply a warm





compression to help disperse and absorb local stasis of blood. Seek medical advice as indicated. Document details on location and size, follow-up management

7.

Fainting





Remove needles. Lie patient down with legs raised , if indicated.





Measure & monitor vital signs. Reassure patient and seek medical advice as indicated.

19

Possible complications 8.

Bent needle

Suggested Management







9.

Stuck Needle





10.

Broken Needle

Relax the body part and resume original position if change of position is the cause. Reassure the patient Remove the needle slowly following the course of the bend. NEVER REMOVE WITH FORCE. Seek medical advice as indicated. Relax patient and alter position slightly. Reassure patient




EITHER Massage skin around the needle lightly, leave a while, then remove needle. OR




Put 1-2 needles around the stuck needle and then gently remove the stuck needle.






Reassure patient. Keep position and do not move. If the broken needle is exposed from the skin, remove it with forceps.




If the broken part is leveled with skin, give a light pressure around the surrounding skin to expose the tip, then remove the broken




needle. If surgical removal is the choice,mark the skin with a radio opaque object e.g. paperclip stuck to skin. Refer patient to Emergency Department immediately for further management.

20

Possible complications

Suggested Management

11.

Local infection




Refer for medical management.

12.

Pneumothorax




Refer for urgent medical management IMMEDIATELY.

13.

Needle Stick Injury





Encourage bleeding and wash wound well. Blood test for Hepatitis, HIV status for both therapist and patient.

21

Application of Electro-acupuncture (EA) A. Equipment 1. You must use a biphasic stimulator, designed for EA. Direct current must be avoided in order to prevent polarization of the needle due to electrolysis. 2. Do not use needles with a plastic handle.

B. Application Procedure 1. Place each pair of needles in acupuncture points according to: a. type of stimulation b. area of pain c. distal points d. meridians 2. Select needles to be paired up for EA. 3. Do not apply electrodes circuiting across the heart. 4. Minimum distance between two needles in a pair should be 3-5cm while maximum distance be 20-30cm. 5. Insert needles to the selected acupuncture points till acupuncture sensations are achieved. 6. Connect the wires to the handles. 7. Turn on the device and raise the intensity slowly till muscle contraction (for use with Low Frequency) or paraesthesia (for use with high frequency) is reported from the patient. 8. Set Treatment time e.g. 20-30 minutes. 9. Turn down intensity and switch off the device before disconnect from the patient.

C. Choice of Parameters 1. Low Frequency(LF), 2-10Hz: stimulate the A-delta fibres, give release of endogenous opioids, endorphins and produce muscle contraction. 2. High Frequency(HF), 80-100Hz: stimulate the A-beta fibres, block pain on segmental level through “pain gate mechanism”, it produces paraesthesia. 3. Combination of LF and HF, e.g.2/15Hz (a continuous 2 Hz frequency along with intervening but intermittent pulse trains of 15 Hz): stimulate A-delta fibres, give release of maximum endogenous 22

opioids, endorphins and enkaphelins. 4. Distal points: often LF (2/4Hz), the main issue for using distal points is to prolong the treatment effect by activating central descending inhibitory pathways. 5. HF in area where no muscle-contractions are possible, e.g. around joints. 6. HF in patient with spasicity.

23

Application of Auricular Acupuncture Press Needle and Bead A. Auricular Acupuncture 1. Select the acupuncture points and mark with pressure, or detect the most tender sites with the point finder. 2. Clean the skin with warm water and liquid soap to remove the natural oil and dirt from skin and dry well. 3. The needling site must be disinfected prior to acupuncture using disinfectant such as 70-80% ethanol, 60-70% isopropanol, 0.5-1.0% w/v chlorhexidine in alcohol or povidone-iodine. 4. The disinfectant should be left on the skin for at least 1 minute and then allowed to dry. 5. If acupuncture needles are inserted into the cartilage of the ear, the skin should be prepared by using disinfectant such as povidone-iodine or 0.5-1.0% w/v chlorhexidine in alcohol. 6. The disinfectant should be left on skin for at least 1 minute and then allowed to dry. [Note: all practitioners must check for iodine allergy if using disinfectant containing iodine. For those patient allergic to iodine, chlorhexidine in alcohol is suitable as a substitute.] 7. Use small sterile disposable needles with 1/2 to 1 inch, either ipsilaterally or bilaterally. 8. Insert needle quickly through the skin. 9. Leave in place for 20-30 minutes for maximal effect. 10. Electroacupuncture may be applied. 11. Use light weight clips to connect to needles in pair. Tape it if necessary.

24

B. Semi-permanent Press Needle (It is about 1.5mm long small needle with a head like a thumbtack) 1. Clean the skin with warm water and liquid soap to remove the natural oil and dirt from skin and dry well. 2. The needling site must be disinfected prior to acupuncture using disinfectant such as 70-80% ethanol, 60-70% isopropanol, 0.5-1.0% w/v chlorhexidine or povidone-iodine. 3. The disinfectant should be left on the skin for at least 1 minute and then allowed to dry. 4. If acupuncture needles are inserted into the cartilage of the ear, the skin should be prepared by using disinfectant such as povidone-iodine or 0.5-1.0% w/v chlorhexidine in alcohol. 5. The disinfectant should be left on the skin for at least 1 minute and then allowed to dry. [Note: all practitioners must check for iodine allergy if using disinfectant containing iodine. For those patients allergic to iodine, chlorhexidine in alcohol is suitable as a substitute.] 6. Press the needle quickly through the skin. 7. Cover and hold the needle in place with plastic skin (flexible collodion) 8. Needles can be retained in place for several days. 9. If there are signs and symptoms of infection of the needling site(s), prompt medical advice and treatment should be sought.

C. Semi-permeable Bead Instead of using the press needles, small ballbearing –like objects can be used. They are stuck over the site with an adhesive tape patch. Patients can apply pressure over the beads to stimulate the points. 25

Patient Information for Acupuncture 1. Please inform your physiotherapist if you have any of the following conditions:  pregnancy  menstruation  on Warfarin or other similar medications  haemophilia  diabetes mellitus  hypertension  epilepsy  pulmonary tuberculosis  hepatitis  infectious diseases  cardiac pacemaker  deep brain stimulator  other electronic implants 2. Please keep the body parts for treatment clean and free of any ointment before acupuncture. 3. Avoid being hungry, thirsty and unduly tired before acupuncture. 4. Avoid wearing tight outfits and metal accessories over the body parts for acupuncture. 5. During acupuncture, please relaxed and do not change position or move. 6. Please empty your bladder before acupuncture. This is especially important if acupuncture is applied to the lower abdominal region. 7. Do not touch the needles or other acupuncture equipment. 8. Do not fall asleep during acupuncture. 9. During acupuncture, you may have one or more of the following sensations: soreness, heaviness, fullness, local or radiating paraesthesia, and warmth. These sensations are normal. Such sensations may last for a period of time after treatment. 10. After acupuncture, there may be mild bruising over the treatment area, it will subside gradually. 11. If you have any discomfort during acupuncture, please inform your physiotherapist immediately. 12. Please consult your physiotherapist for any queries. 26

接受針刺治療病人 接受針刺治療病人須知 病人須知 1. 病人如有任何以下疾病或情況，請立刻通知物理治療師： ˙ 懷孕 ˙ 月經 ˙ 正服食薄血丸或同類抗凝血藥物 ˙ 血友病 ˙ 糖尿病 ˙ 高血壓 ˙ 羊癇症 ˙ 肺結核 ˙ 肝炎 ˙ 傳染病 ˙ 裝有心臟起搏器 ˙ 裝有腦部深層刺激儀器 ˙ 裝有其他電子植入儀器 2. 每次應診前，請保持身體清潔，及避免在針刺治療部位塗上任何 藥膏。 3. 接受針刺治療前，應避免過飢、口渴或過累。 4. 請勿穿著緊身衣服或於治療部位配帶任何金屬物件。 5. 針刺治療時，請放鬆，切勿轉換姿勢或移動針刺部位。 6. 請於治療前如廁，這對於下腹部位的針刺治療尤其重要。 7. 切勿觸摸針或針刺用品及儀器。 8. 針刺治療時請保持清醒，切勿睡著。 9. 針刺治療時，可能會感到：酸 / 重 / 脹 / 麻 / 微溫。這是正常 針感，可能會於治療後持續一段時間。 10. 針刺治療後，針刺部位可能會有微瘀，一般會於數天後消失。 11. 於針刺治療時如感到不適，請立即通知物理治療師。 12. 如有任何疑問，可向物理治療師查詢。

27

_______________________ Hospital Patient Gum Label

Physiotherapy Department Acupuncture Treatment Record Sheet

Physiotherapist I/C: _______________________ Contraindication checked: □ Yes Treatment explained: □ Yes Information sheet read: □ Yes Verbal consent obtained: □ Yes Acupuncture Details Acu-points Selected WHO

Date Penetration

Disinfectant Applied*

Nomenclature

Depth

Insertion

(inch/cm)

Angle#

1/

L/R

A/B/C/D

P/O/H

2/

L/R

A/B/C/D

P/O/H

3/

L/R

A/B/C/D

P/O/H

4/

L/R

A/B/C/D

P/O/H

5/

L/R

A/B/C/D

P/O/H

6/

L/R

A/B/C/D

P/O/H

7/

L/R

A/B/C/D

P/O/H

8/

L/R

A/B/C/D

P/O/H

9/

L/R

A/B/C/D

P/O/H

10/

L/R

A/B/C/D

P/O/H

Total number of needles inserted Total number of needles removed Warning: remain relax, keep in position, report discomfort Electrical Stimulation Protocol

Frequency (Hz) Duration (Min)

Adverse Response:

F – Fainting

H – Haematoma

S – Stuck needle B – Broken needle O – Others Physiotherapist Signature *Notes:

#Notes:

Disinfectant:

Insertion angle:

A – 70-80% ethanol

B – 60-70% isopropanol

C – 0.5-1% w/v chlorhexidine

D – povidone-iodine (iodine allergy checked)

P – perpendicular

O – Oblique

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H – Horizontal

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3

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Han J. S. 1998. The Neurochemical Basis of Pain Relief by Acupuncture. Hubie Science and Technology Press volume 2.

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13

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15

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Song J.Y. , Sohn J.W., et al. 2006. An Outbreak of Post-acupuncture Cutaneous Infection due to Mycobacterium Abscessus. BMC Infectious Diseases 6:6 doi:10.1186/1471-2334-6-6.

21

Tai D. 1987. Acupuncture & Moxibustion. Gower Medical Publishing. D.

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The British Acupuncture Council 2006. Code of Safe Practice.

23

The Chinese Medicine Registration Board of Victoria 2004. Infection Control Guidelines for Acupuncture-Consultation Draft.

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WHO 1995. Guideline for Clinical Research on Acupuncture. WHO Regional Publication, Western Pacific Series, No. 15.

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Woo Patrick C.Y., Leung K.W., Wong Samson S.Y. et al. 2002. Relatively Alcohol-resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment. Journal of Clinical Microbiology. 40:1219-1224.

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