Management of Adverse Reactions in Acupuncture & Dry Needling

Painful Treatment

• If pain persists while the needle is inserted it should be removed
• If pain persists following a treatment, the patient can be advised to apply heat or ice.

Hematoma

• Care should be taken to avoid injuring blood vessels, however if bleeding does occur, apply pressure to the area with a wadded tissue or cotton swab after the needle has been withdrawn.
• Ice can be used locally to minimize bruising.
• Bruising should be brought to the patient’s attention as well as documented in notes.

Fainting

• This may be caused by nervous tension, hunger, fatigue, incorrect positioning, excessive stimulation of the needles or if the patient is autonomically labile
• To avoid fainting, treatment in a lying position is preferable, don’t use too many needles, and use minimal stimulation the first treatment
• If fainting occurs stop needling and remove all needles, make sure the patient is lying down and consider raising their legs, offer water, warm tea or something to eat and reassure the patient. Symptoms should abate after resting.
• Incident must be documented in treatment notes.
• Incident must be reported and an incident reporting form must be filled out.

Stuck Needle

• A stuck needle may occur due to spasm of the local muscle after insertion of the needle, twisting the needle with too much amplitude or in only one direction causing muscle fibers to bind, or if the patient alters position whilst the needles are in-situ
• Every attempt should be made to avoid the above
• If the needle is stuck due to over rotation, then rotate in the opposite direction and remove
• If the needle is stuck due to muscle tension, leave the needle in for a short period of time, relax the tissue around the needle with massage, ice massage, wiping an alcohol swab around it or by inserting 1-2 needles around the stuck needle, then remove the needle.

Bent Needle

• A bent needle may occur if the needle strikes hard tissue, there is a sudden change in patient’s posture, or a strong contraction of the muscle occurs during trigger point needling.
• To prevent a bent needle occurring, insert the needle carefully with the patient in a comfortable and relaxed position.
• If a bent needle occurs instruct the patient not to move, relax the local muscle and remove the needle slowly following the course of the bend.

Broken Needle

• This may occur due to poor quality of needle, strong muscle spasm, sudden movements of the patient when the needle is in-situ or by withdrawing a bent needle.
• The likelihood is very rare, particularly with single use sterile needles as there is no metal fatigue from repeated use and autoclaving
• The patient should be advised to remain calm to avoid the needle going deeper. If the broken needle is exposed remove the broken section with tweezers, if not exposed press the tissue around the insertion site until the broken needle is exposed and remove with tweezers
• If the needle cannot be removed in the clinic, medical attention must be sought so that the needle can be removed surgically.
• Incidents must be document within the treatment notes, reported and an incident report form completed.

Infection

• Skin in the region to be needles should be inspected and if infection is suspected needling should be deferred and medical advice should be sought
• Care should be taken when needling very thin or fragile skin due to the risk of infection.

Excessive Drowsiness

• A small percentage of patients may feel excessively relaxed and sleepy after acupuncture treatment – they should be advised not to drive until they have recovered.
• For patients that this occurs with, it is advisable not to leave the needles in for a significant amount of time or to over stimulate them.

Pneumothorax

• See precautions regarding needling around the thorax
• The symptoms and signs of a pneumothorax may include shortness of breath on exertion, chest pain, dry cough or decreased breath sounds on auscultation. These symptoms may not occur until several hours after the treatment.
• Risk should be discussed with patients. It is also advisable to avoid needling the thorax in individual who may be exposed to marked alterations in altitude (i.e. flying or scuba diving).
• If a pneumothorax is suspected the patient must be sent urgently for an x-ray and medical management.

Needling over the Spinal Cord

• Care should be taken when needling between the spinous processes of vertebrae or over nerves (GV or inner BL meridians) as the distance from the skin to the spinal cord/roots varies from 25-45mm.
• Do not puncture deeply.

Needling over Abdominal Organs

• Do not needle deeply over organs.

Miscarriage

• See precautions/contraindications.

Needle Stick Injury

• Needle stick injury may occur when the therapist inadvertently is pricked by the needle after it has been withdrawn from the patient. If this occurs, wash well around the site of penetration, encourage bleeding, have blood tests for Hepatitis B and C and HIV/AIDS. The patient may also be requested to have the same blood analysis done.
• All physiotherapists are to be vaccinated against Hepatitis B.