Filiform needle therapy is the most commonly used acupuncture technique. To prevent accidental needling, attention must be paid to the following aspects:
1. Selecting the Right Needles
(1) Specification: This refers to the thickness and length of the needles. Filiform needles come in six lengths: 13mm (0.5 inches), 25mm (1 inch), 40mm (1.5 inches), 50mm (2 inches), 75mm (3 inches), and 100mm (4 inches); and seven thicknesses: 0.45mm (26 gauge), 0.40mm (28 gauge), 0.35mm (29 gauge), 0.30mm (30 gauge), 0.25mm (32 gauge), 0.22mm (34 gauge), and 0.20mm (36 gauge). It is essential to choose the appropriate needle based on the patient’s condition, constitution, and the selected acupoint area. For first-time patients, children, those with weak constitutions, and needle-phobic individuals, it is advisable to select thinner and shorter needles; for needling points on the chest and back, short needles should be used, while fine needles (generally 30-32 gauge) are recommended for eye acupoints. Additionally, the needle should be selected according to the safe depth of the acupoint to avoid exceeding the safe depth while searching for the needle sensation.
(2) Quality Check: Before needling, the quality of the filiform needles should be carefully inspected, including the needle tip, needle body, needle root, and needle handle.
1. Needle Tip: It should be round and not blunt, and not too sharp, ideally resembling a pine needle. Before use, check if the needle tip has any barbs or hooks by wrapping the needle body with a disinfected cotton ball and withdrawing it while rotating. If there is a sensation of resistance or if cotton fibers are attached to the needle tip upon withdrawal, the needle should be discarded.
2. Needle Body: It should be straight, smooth, lubricated, and elastic. Before use, check for any bends, creases, rust, or peeling. Generally, slightly bent needles can be straightened and used, while those with other issues should be discarded.
3. Needle Root: The needle root is the junction between the needle body and the needle handle. Clinical practice has shown that needle breakage often occurs at the needle root, so it is crucial to check for looseness or corrosion at this point. If such conditions are found, the needle should be discarded.
4. Needle Handle: This refers to the part wrapped with metal wire. Looseness here can also lead to acupuncture accidents, especially during warming acupuncture, which can cause the moxa to fall off and cause burns. The right hand should hold the needle handle while the left hand pinches the needle body with the thumb and index finger, pulling and shaking to check for looseness.
2. Emphasizing Disinfection
The disinfection referred to here mainly concerns needle disinfection.
Although ancient physicians lacked today’s concepts of disinfection, they recognized the need for proper handling of needles to eliminate “toxic gases” and reduce the risk of infection through long-term clinical practice. For example, “The Great Compendium of Acupuncture and Moxibustion, Volume Four” provides a detailed introduction: “First, heat the iron wire until red in fire… then apply toad venom to the needle, reheat slightly, ensuring it does not turn red, and after the third application, insert it into the skin of cured meat, and boil the needle in water with medicinal herbs (including musk and fourteen other ingredients) until the water evaporates, then cool and remove the needle. Insert it into yellow earth over a hundred times until it turns bright to eliminate fire toxins.”
Modern needle disinfection has gradually gained importance and development with the introduction of Western medicine. As early as the 1930s and 1940s, some acupuncturists began using alcohol for disinfection. By the 1950s, a more complete needle disinfection method was proposed: practitioners should wash their hands with soap and a brush before acupuncture, sterilize needles by boiling them or soaking them in 75% alcohol, wipe the acupuncture site with an alcohol cotton ball, and apply pressure with a disinfected cotton ball if bleeding occurs. Currently, needle disinfection methods have become widespread in clinical practice. To find an effective and simple disinfection measure, some institutions have conducted clinical studies comparing the use of 75% alcohol and 2% chlorhexidine solution for disinfection, with results showing that alcohol cotton ball disinfection is a simple and effective method, while chlorhexidine solution is less ideal.
Needle disinfection should include the needles, the acupuncture points, and the practitioner’s fingers. Needles that are not properly disinfected or skin that is not adequately prepared before needling can lead to infections, including serum hepatitis. Among these, the needles are the most critical, as they can carry a large number of bacteria and viruses, and inadequate disinfection can lead to their introduction into the body.
To prevent infection, the following points should be noted regarding needle disinfection:
(1) Needle Disinfection: Needles should be disinfected immediately after use, and those not in use should be regularly sterilized under high pressure, every three days in summer and once a week in winter. Needles that have not undergone high-pressure sterilization should never be used. High-pressure sterilization generally involves placing filiform needles and other acupuncture tools in a special metal sterilization box and placing them in a high-pressure steam pot at 15 psi and 120°C for at least 15 minutes. Each sterilized needle must be re-sterilized after each use.
Boiling Disinfection: If conditions do not permit, needles can be placed in a clean water pot and boiled for more than 15 minutes. Generally, sodium bicarbonate can be added to the water to create a 2% solution, which raises the boiling point to 120°C and reduces the corrosive effect of boiling water on the needles. Glass containers can also be disinfected using this method.
Alcohol Disinfection: In emergency situations, 75% alcohol can be used for soaking for 20-30 minutes. Additionally, for needles that are not suitable for high-pressure or boiling disinfection, such as skin needles, alcohol soaking can be used for disinfection.
In recent years, many regions both domestically and abroad have promoted the use of disposable acupuncture needles sterilized with ethylene oxide by factories. Needles used for point injections must be disposable.
(2) Practitioner Finger Disinfection: Practitioners should trim their nails daily, wash their hands thoroughly with soap before the procedure, and disinfect with alcohol cotton balls, avoiding the use of chlorhexidine solution. First, hold an alcohol cotton ball with the left hand and wipe from the fingertips down to the base, changing to a new cotton ball to disinfect the remaining parts. After the alcohol has evaporated, the right hand should hold an alcohol cotton ball to disinfect the left fingers. Then, using clean tweezers, grasp the needle handle, wrap the needle body with a sterile cotton ball, and apply pressure with the left index or middle finger beside the acupoint. For needles shorter than 2 inches, use the push-pull method, with the right thumb and index finger holding the needle handle, and the middle finger pressing against the opposite side of the finger applying pressure, using the fingertip to support the lower part of the cotton ball-wrapped needle body, and pushing the needle in to the appropriate depth. For needles longer than 2 inches, use the tapping method, with the left thumb and index fingers pressing on both sides of the acupoint and slightly tightening, while the right hand holds the lower end of the cotton ball-wrapped needle, exposing 2-3 mm of the needle tip, aiming at the acupoint and inserting it to the appropriate depth, then manipulating the needle as required.
(3) Acupoint Disinfection: Skin disinfection should use hemostatic forceps to hold the alcohol cotton ball, and it is prohibited to use hands to wipe from top to bottom, as this not only fails to achieve disinfection but also spreads bacteria. After the alcohol has dried, needling can begin. Each acupoint should be disinfected with a separate alcohol cotton ball, which should not be too dry or too wet, nor should it be torn and reused. It is also inadvisable to use one cotton ball to disinfect multiple acupoints. Some suggest that a cotton ball with a diameter of 1.5 cm can disinfect up to three acupoints at most. During disinfection, the cotton ball should be wiped in a circular motion from the inside out. After disinfection, wait for the alcohol to evaporate before needling. After removing the needle, a dry alcohol cotton ball or a dry cotton ball that has been sterilized at high temperature should be pressed against the needle hole. Disinfection should be stricter in areas such as joints, eye sockets, auricles, and hairy areas, as well as for acupoints used for injections. It is advisable to first apply 2% iodine tincture to the local skin of the acupoint, then use 75% alcohol to remove the iodine, wiping from the inside out with an alcohol cotton ball.
3. Attention to Technique
(1) In the neck and back areas, it is essential to understand the local anatomy and master the direction of needling, avoiding random or deep needling.
(2) Near nerve trunks and superficial nerve distributions (such as Neiguan (Pericardium 6), Yanglingquan (Gallbladder 34), and Du Mai (Governing Vessel) acupoints), needling techniques should be gentle. Avoid strong twisting or vigorous thrusting; if there is a sensation of electric shock or intense needle sensation, gently withdraw the needle or change direction, avoiding strong techniques to prevent nerve and spinal cord injury. The author has witnessed an elderly woman who, during the “Cultural Revolution,” was treated at the Dazhui (Governing Vessel 14) acupoint, and after experiencing an electric shock sensation, the physician continued with strong techniques, resulting in lifelong disability due to right limb spasm.
(3) For patients with weak constitutions and weak or absent needle sensations, it is advisable to leave the needle in place and wait for the qi, avoiding prolonged attempts to find the needle sensation in multiple directions to prevent nerve and vascular damage.
(4) Practitioners should be clear about the pathways of the meridians to respond promptly in case of abnormal situations (such as reports of electric shock sensations at Neiguan), preventing adverse effects from worsening and causing irreversible damage.
4. Avoiding Stuck Needles, Bent Needles, and Retained Needles
Stuck needles refer to a situation where, after insertion, the needle feels heavy and difficult to withdraw during twisting and lifting. Bent needles occur when the needle body bends while in the acupoint area. Retained needles refer to the situation where one or more needles are left in the patient’s body after treatment. The causes of stuck needles are related to excessive force during insertion, uneven twisting and lifting, or twisting in a single direction, causing muscle fibers to wrap around the needle body, or the patient being tense, leading to muscle spasms. Bent needles are caused by sudden changes in the patient’s position after needling or external impacts on the needle handle. Retained needles often occur due to the practitioner’s busyness, leading to a failure to check the needled area carefully, or when one practitioner needles and another removes the needle, resulting in oversight. Retained needles are often found in hidden areas of the body, such as covered by hair on the head or in the popliteal fossa. These three situations are quite common in acupuncture practice.
(1) Prevention Methods: For stuck needles, do not apply excessive force during insertion; after quickly breaking the skin, slowly advance the needle until the qi is obtained. When twisting the needle, do not twist in the same direction. For patients who are tense, apply pressure to the acupoint before needling. For bent needles, instruct the patient to maintain a comfortable position before needling and advise them not to change positions arbitrarily afterward. Avoid external impacts on the needle handle. For retained needles, the best method is to record the number of needles inserted before treatment and count the number of needles removed afterward. If this is difficult, carefully check for needles during removal, especially in hidden areas such as those covered by hair.
(2) Handling Methods: If a stuck needle occurs due to the patient’s tension, the retention time can be appropriately extended; or apply pressure beside the needled area, or insert another needle. If the stuck needle is due to improper twisting or lifting, gently twist left and right or reverse the direction to withdraw the needle. If a bent needle occurs, for minor bends, withdraw it slowly following the curve; for larger bends, instruct the patient to relax their muscles and gently move the needle body, withdrawing it along the curve; if there are multiple bent areas, adjust the angle of the needle handle and withdraw it gradually in segments. Note that in all these situations, do not pull forcefully to avoid needle breakage accidents. For retained needles, generally, simply remove the needle and ensure disinfection of the acupoint; if stuck or bent needles occur, handle them as described above.
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