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AOM Clinical Procedures, Safety, Adverse Events

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AOM Clinical Procedures, Safety, Adverse Events Clean Needle Technique Page 1 Clean Needle Technique 7th Edition CONTENTS • Part I: AOM Clinical Procedures, Safety, Adverse Events and Recommendations to Reduce AEs (pg.1) • Part II: Best Practices for Acupuncture – CNT (pg.68) • Part III: Best Practices for Related AOM Office Procedures (pg.101) • Part IV: Infections Associated with Acupuncture and Related Healthcare Practices (pg.131) • Part V: Personnel Health, Cleanliness and Safety Practices (pg.168) • Part VI: Cleaning and Pathogen Reduction Techniques in Healthcare and AOM Practice Locations (pg.189) • Part VII: Office Procedures for Risk Reduction (pg.204) • Part VIII: Appendices (pg.227) • FAQ (pg.240) The majority of the acupuncture‐ Part I: associated adverse events are ________. AOM Clinical Procedures, Safety, Adverse Events (AEs) and A. Infections Recommendations to Reduce AEs B. Pneumothorax C. Serious organ injury D. Serious tissue injury • Skin and Soft tissue infections • Mycobacterium abcessus • Staphylococcus spp. HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 2 Identify those acupuncture points which lie over or next to major vessels. Identify an acupuncture point which lie over radial artery. • LU 9 radial artery • HT 7 ulnar artery A. HT7 • HT 1 axillary artery • BL 40 popliteal artery B. LU9 • ST 42 dorsalis pedis artery C. HT1 • ST 9 carotid artery D. BL40 • ST 12 supraclavicular artery and vein • ST 13 subclavian artery • SP 11 femoral artery • LR 12 femoral artery and vein CNT (7th Ed.) p.5 Identify an acupuncture point which lie Identify an acupuncture point which lie over supraclavicular artery and vein. over femoral artery and vein. A. ST9 A. BL40 B. ST12 B. ST41 C. ST13 C. HT1 D. ST42 D. LR12 HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 3 _________ may increase the tendency De Qi response EXCEPT for bruising and bleeding. A. Levothyroxine (Synthroid) A. Heavy B. Metoprolol (Lopressor) B. Tight 득기(得氣) C. Warfarin (Coumadin) C. Tingling D. Atorvastatin (Lipitor) D. Allodynia • Allodynia: a painful response to a normally innocuous stimulus • Hyperalgesia: an increased response to a painful stimulus ________ consumption may also heighten Patients may experience lightheadedness anxiety and heightened anxiety is associated or faintness more commonly __________. with increased perception of pain. A. during the first time they receive acupuncture A. Caffeine B. if they are nervous B. Alcohol C. if there is excessive needle manipulation C. Smoking D. if the patient is particularly hungry or tired prior D. Dark chocolate to needle insertion E. All of the above HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 4 If a needle that was rotated in one direction The best safety guidelines for needle becomes stuck, __________________. removal? A. rotate the needle forward in the same direction. A. Count and write down the number of needles used. B. rotate the needle back in the opposite direction. B. Remember the number of needles. C. pull the needle upward. C. Ask your assistant to remember the number of needles. D. push the needle downward. D. Ask patient to remember the number of needles. Aggravation of symptoms occurs as a result of acupuncture Pneumothorax that results from a complication of a on an infrequent but consistent basis. Aggravation of diagnostic or therapeutic intervention. symptoms is reported both as a potential adverse event and as an intended response to treatment, known as A. Primary spontaneous pneumothorax (PCP) _______________ or “healing crisis.” B. Secondary spontaneous pneumothorax (SPS) C. Iatrogenic pneumothorax A. Blue moon phenomenon D. Traumatic pneumothorax B. Paranormal phenomenon C. Olympic phenomenon D. Menken phenomenon • 瞑眩反應 (명현반응) = Menken phenomenon HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 5 Symptoms of acupuncture‐related Patients at increased risk for pneumothorax from pneumothorax EXCEPT acupuncture include ______________ EXCEPT A. Dyspnea on exertion B. Skin Erythema C. Tachypnea A. Cigarette smokers D. Chest pain B. Marijuana smokers C. Lung cancer D. Patient who are on corticosteroids E. Obesity • Symptoms of acupuncture‐related pneumothorax • dyspnea on exertion, tachypnea, chest pain • dry cough, cyanosis, diaphoresis The primary areas associated with acupuncture or Safe needling depth to avoid pneumothorax dry needling‐induced pneumothorax are the regions of the thorax including ________ EXCEPT on most patients can be as little as ________ (less than the face width of a U.S. nickel, 20‐cent Euro coin, Canadian 25‐cent piece or English 20 pence.) A. Upper trapezius B. Thoracic paraspinal A. 1‐2 mm C. Supraspinatus B. 10‐20 mm D. Medial scapular E. Subclavicular areas C. 20‐30 mm D. 30‐40 cm HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 6 Point most frequently associated with In regards to inadvertently puncturing the pneumothorax events in the Chinese literature are lung, liver, and heart, which point should you take extra care in needling? A. GB21 B. UB13 A. KD11 C. ST12 B. LU1 D. RN22 C. GB21 CNT P.12 D. UB13 • Points most frequently associated with pneumothorax events in the Chinese literature are: GB E. KD22 21 (30%), BL 13 (15%), ST 12 (10%), RN 22 (10%), infrequent events occurred at BL 18, Ren 15, Ren 14, SI 9, SI 13, and Dingchuan. • Peuker & Gronemeyer identify risk points ST 11 and ST 12, LU 2, ST 13, KI 22‐27, and ST 12‐18. However, any points needled in the thoracic body region risk penetrating the lung, including the front, back, or lateral body, the lower neck, shoulder and scapular region as well as the chest, ribs and just below the ribs depending on the position of the patient. Oblique or transverse needling on points located on Puncturing the liver or spleen may cause the chest and avoiding an upward direction at ___________ EXCEPT _________ is critical to prevent heart injury. A. RN17 A. internal bleeding B. RN16 B. rigidity of the abdominal muscles C. RN12 C. rebound pain upon pressure D. RN15 D. dyspnea upon exertion HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 7 Puncturing the kidney may cause ______ EXCEPT Needling _______ in an infant is prohibited. A. pain in the lumbar region A. DU22 B. tenderness and pain upon percussion around the B. DU20 kidney region C. Yintang C. bloody stool D. UB12 D. bloody urine The source of autogenous infection? When using a multi‐needle pack of sterilized needles, once the packaging is opened for one patient visit, any unused needles __________ A. The practitioner B. The patient himself A. must be discarded properly C. The other patient B. must be autoclaved before next time use D. The alien C. can be saved for another patient D. can be saved for next day HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 8 When needle stabilization is needed, the If the broken needle is completely practitioner should use _________ to under the skin stabilize the shaft of the needle. A. Remove it with forceps A. Sterile cotton B. Press the tissues around the site gently until the broken end is exposed B. Sterile gauze C. See medical help immediately C. Glove D. Cover with bandage D. A or B E. B or C • To prevent broken needles • Critical: • Inspect needle for defects in manufacturing before use. • Strongly recommended: • Use only single‐use sterilized needles. • Never insert a needle to the handle. Allergies to the moxa smoke, or response to the Possible adverse effect of moxibustion volatile substances such as ________ in the moxa smoke may create nausea or allergic reactions. EXCEPT A. Borneol A. Rubefaction B. Sulfur B. Blistering C. Stomach upsets C. Aluminum D. Impotence D. Acetate • Adverse events of moxibustion • rubefaction, blistering, itching sensations • discomfort due to smoke, general fatigue, stomach upsets, flare‐ups, headaches, and burns HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 9 Acupuncture textbooks reinforce the need to avoid Infections associated with moxibustion are secondary the head and face for moxibustion by reporting that adverse events related to burns. Burn prevention is critical. ancient texts advised caution or prohibition when When more than ______ of skin is involved with a burn, applying moxibustion to the following points, practitioners need to assess the amount of skin damage and EXCEPT consider a referral to a medical practitioner for treatment. A. DU23 A. 0.5 cm B. ST8 B. 1 cm C. DU20 C. 2 cm D. ST9 D. 3 cm Take a careful patient history to identify ________, ________ or other conditions that might limit a Typically, cups are left on the patient’s skin for ______ patient’s response to pain or the ability to sense minutes, but may be left in place for up to ____ heat from heat lamp. minutes, and leave a temporary reddish mark that is a result of cutaneous petechiae and ecchymosis. A. diabetes, chronic kidney disease B. diabetes, neuropathy A. 2‐10, 20 C. hypertension, neuropathy B. 2‐10, 45 D. hypertension, chronic kidney disease C. 10‐20, 45 D. 10‐20, 60 HB Kim, www.AcupunctureMedia.com Clean Needle Technique Page 10 What type of cupping increase the risk of Least common outcome of cupping pneumothorax or other organ puncture if done over the thoracic region? A. Bullae B. Petechiae A. Fire cupping C. Keloid scarring B. Suction cupping D. Ecchymosis C. Wet cupping D. Empty cupping E. Needle cupping Most common outcome of cupping For wet cupping, the skin at the site should be punctured using A. Bullae B. Panniculitis A. Sterile lancets C. Keloid scarring B. Pre‐sterilized traditional three‐edged needles D. Koebner phenomenon C. Plum blossom tool D. All of the above • Bullae & Hemorrhagic bullae • They can form crusting scabs as they heal, which can take up to 2 weeks. • The opening of the skin barrier over time creates exposure and risk of infection.
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