OSHA education & Not OSHA compliant!! Precautions, contraindications and safety of dry needling. For employers the must:

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1 OSHA education & Precautions, contraindications and safety of dry needling Bloodborne pathogens are infectious micro-organisms present in blood that can cause disease in humans. These pathogens include, but are not limited to: hepatitis B virus (HBV) hepatitis C virus (HCV) human immunodeficiency virus (HIV) Workers exposed to bloodborne pathogens are at risk for serious or life-threatening illnesses. We MUST wear gloves!! A set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood-borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other blood-borne pathogens According to Regulations (Standards - 29 CFR) published by the US Occupational Safety and Health Administration, gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin For employers the must: Establish an exposure control plan Implement the use of universal precautions Provide personal protective equipment (PPE), such as gloves, gowns, eye protection, and masks Make available hepatitis B vaccinations to all workers with occupational exposure Provide information and training to workers Not OSHA compliant!! Maintain worker medical and training records 1

2 Precautions/ contraindications Patients with a needle aversion or phobia may object to the physical therapy treatment with dry needling. With appropriate education, however, these patients may still consider dry needling. Patients with significant cognitive impairment may have difficulty understanding the treatment parameters and dry needling intervention. If you cannot communicate with them in some form then dry needling may not be the best option Patients who are unable to communicate directly or via an interpreter may not be appropriate for dry needling treatments. Patients MUST to be able to give consent for the treatment with dry needling. Local skin lesions must be avoided with dry needling. Don t needle near open wounds or severe acne Local or systemic infections are generally considered to be contraindicated, but there are exceptions, such a Lyme disease. i.e. someone with a fever should not be getting treated Do not needle where there is local lymphedema or swelling note: there is no evidence that dry needling would cause or contribute to increased lymphedema, ie, post-mastectomy, and as such is not a contraindication Some patients may be allergic/ sensitive to certain metals in the needle, such as nickel or chromium. Can use silver or gold plated needles instead This patient was treated with nickel needles. The needles were left in place for about minutes. Severe hyperalgesia or allodynia may interfere with the application of dry needling, but should not be considered an absolute contraindication. Patients with an abnormal bleeding tendency, i.e., patients on anticoagulant therapy or with thrombocytopenia, must be needled with caution. Dry needling of deep muscles, such as the lateral pterygoid or psoas major muscle, that cannot be approached with direct pressure to provide hemostasis may need to be avoided to prevent excessive bleeding. Dry needling should not be used in the presence of vascular disease, including varicose veins. Patients with a compromised immune system may be more susceptible to local or systemic infections from dry needling, even though there is no documented increased risk of infection with dry needling. Can opt to make a sterile field to needle, or just don t needle them (when in doubt stay out) Dry needling during the first trimester of pregnancy, during which miscarriage is fairly common, must be approached with caution, even though there is no evidence that DN has any potential abortifacient effects Later that day, the patient noticed an itching feeling at the needle sites. 2

3 Caution is warranted with dry needling following surgical procedures where the joint capsule has been opened or when implants have been inserted. Dry needling is absolutely contraindicated in the presence of implants. Please note that breast, pectoral, deltoid, biceps, buttock, and calf implants are more and more common. Although septic arthritis is a concern following joint surgery, dry needling can still be performed as long as the needle is not directed toward the joint or implant. If there is every any doubt /OR Dry Needling I Regardless of how safe a technique is!!!!! Brady S, mcevoy J, Dommerholt J, Doody C Aug;22(3): Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists 82.7%, n=6, % n=1,317 3

4 1,463 minor AEs 19.8% Risk of a significant adverse event with Aspirin: 18.7% Ibuprofen: 13.7% RISK of Significant AE: Paracetamol: 14.5% 0.04% Acupuncture is also considered safe but accidents can happen and we can all learn from them.. Peuker E. Case report of tension pneumothorax related to acupuncture. Acupuncture in Medicine, 2004;22(1):40-43 Lee B et al. Bilateral tension pneumothorax: 2 Autopsy cases. Basic and Applied Pathology 2010; 3:

5 Cardiac Tamponade o 6 cases reported (Peuker and Grönemeyer, 2001) o 26 cases reported (Ernst and Zhang, 2011) Kim DH, Dim S-C, Youn HC. Surgical treatment for intra-thoracic migration of acupuncture needles. J Korean Med Sci 27: , 2012 Peripheral Nerves Injuries (Peuker and Grönemeyer, 2001) o Foot drop secondary to needle in peroneal nerve o Median nerve neuropathy after breaking off in carpal tunnel Lee SW et al. A needle penetrating the stomach cavity after acupuncture. Clin Endosc. 2014;47: Central Nervous System Injuries (Peuker and Grönemeyer, 2001) o 10 cases with injury to SC or nerve roots o 4 due to migrated needle fragments o 6 due to direct injury Did you know that: the distance from the surface of the skin to the spinal cord or the roots of the spinal nerves ranges from 25 to 45 mm Needle into the left anterior parasternal area at the level of the 4th intercostal space by a professional acupuncturist....into the right ventricle Chun et al. Journal of Cardiothoracic Surgery 2014, 9:61 Spine 2011;36:E891-E893 ² Dry needling by a family physician to neck and arm ² 1 hour after treatment: sudden weakness and numbness (R) UE and LE ² Dx: cervical epidural hematoma ² Had emergency decompressive laminectomy C3-T1 All of the traumatic injuries described in this article could have been avoided if practitioners had had better anatomical knowledge, applied existing anatomical knowledge better, or both. and don t forget about common sense!! Elmar Peuker, Dietrich Grönemeyer Rare But Serious Complications of Acupuncture: Traumatic Lesions ACUPUNCTURE IN MEDICINE 2001;19(2):