Table Of Content

Clean Needle Technique CNT Manual Best Practices for Acupuncture Needle Safety and Related Procedures 7th Edition Published by the Council of Colleges of Acupuncture and Oriental Medicine©2015 CCAOM  Clean  Needle   Technique  (CNT)  Manual     th 7  Edition     Best  Practices  for  Acupuncture  Needle  Safety  and  Related  Procedures     Seventh  Edition Council  of  Colleges  of  Acupuncture  and  Oriental  Medicine   www.ccaom.org   ©  2015  by  the  Council  of  Colleges  of  Acupuncture  and  Oriental  Medicine   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,  N.D.,  L.Ac.   Cover  Design:  Roberta  McGrew   Cover  Photos:  Leaf  ©  123RF.com,  Nanette  Grebe  ©  123RF.com         The  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.  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. 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  .................................................................................  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     i 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  ..............................................................................................................................................  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     ii 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.  Electro-­‐Acupuncture  (EA)  ..................................................................................................................  43   Safety/Adverse  Events  –  A  Review  of  the  Literature  .........................................................................  43   Excessive  Current  ...........................................................................................................................  44   Anatomical  Considerations  ............................................................................................................  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     iii Safety  Guidelines  for  Gua  Sha  ....................................................................................................  53   Disinfection  of  Gua  Sha  Devices  .....................................................................................................  54   Safety  Guidelines  for  Disinfection  of  Gua  Sha  Tools  ...................................................................  55   References  .........................................................................................................................................  55   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  ............................................................................................................  67   Shonishin  Pediatric  Japanese  Acupuncture  Tools  ..............................................................................  67   A  Review  of  the  Literature  .............................................................................................................  67   Preventing  Common  Adverse  Events  .............................................................................................  67     iv 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  ............................................................................................  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     v 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  .........................................................................................................  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     vi

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acupuncture needling and related techniques, the manual may also be beneficially used by Manaka/Japanese Acupuncture Tools .
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acupuncture needling and related techniques, the manual may also be beneficially used by Manaka/Japanese Acupuncture Tools .

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