A Tale of Two Needle Incidents
It’s always the best of times and the worst of times, down in the AERD data. Let’s look at reports from acupuncturists in two different clinics.
While receiving an acupuncture treatment that included Pc 6, this patient fell asleep and her hand rolled over, pushing the needle in deeper so that it got stuck in a tendon. The acupuncturist tried to remove it and couldn’t, so sent the patient to urgent care where the providers x-rayed her arm and saw that the needle was bent and in her tendon. They made a small incision in her skin, and removed it easily. This patient continued getting treatment after this event.
After a treatment that included the points CV 22 and GB 40, this patient felt some lingering sharp sensation at those points and concluded that there were needle fragments still in her body. She proceeded to try to dig them out with her fingernails before contacting the clinic where she received the treatment. An acupuncturist met with her and observed scabs at the needle sites, explained that acupuncture needles don’t shatter into fragments, and suggested that if she had any doubts she should go to her doctor and get an x-ray. This patient had been very anxious during previous treatments and had mentioned that she had a lot of fear around needles. The acupuncturist who met with her after the incident talked with her about how she doesn't seem to like getting acupuncture and offered referrals to a craniosacral therapist or Reiki practitioner.
One of the things you learn as a community acupuncturist is what an amazingly wide range of relationships people have to their bodies, their emotions, and to acupuncture itself. Here we have a perceived adverse event that apparently ended a patient’s relationship with acupuncture, and an objectively verified adverse event requiring medical attention that didn’t.
Neither of these safety incidents could have been anticipated by the acupuncturists involved. Patient A was so relaxed and had such a high tolerance for needle sensation that she was able to inadvertently skewer a tendon. She reminds me of a patient I had back when I made house calls: a WWII veteran inclined to animated conversation who would wave his hands around as he talked to me during his treatment, causing his needles to fly in every direction. I responded by inserting the needles more deeply and warning him that it would probably hurt if he kept doing that. But it didn’t hurt, and when I removed the needles from his hands, some of them looked like corkscrews. Take home messages for both Patient A’s acupuncturist and me: insert needles obliquely. Also, don’t assume anything about anyone’s tolerance for pain. Also, you’re not in control of your patient’s body.
Patient B, on the other hand, was so anxious that she interpreted minor post-treatment sensations as a sign that she had broken needles lodged in her body. I agree with her acupuncturist’s approach of stepping back and evaluating whether acupuncture was a good fit for her, and it sounds like her acupuncturist accomplished that in a kind, supportive way.
Referring back to the safety/risk continuum for styles of treatment, most community acupuncture emphasizes distal treatment with thin needles that allows patients to relax deeply and fall asleep. This style is distinct from more medicalized approaches that emphasize local treatment and strong stimulation, and it probably minimizes certain safety issues for community acupuncturists. How much tissue damage can you do if somebody is relaxed enough to fall asleep? Well, Patient A demonstrates that the answer to that question is not zero! And Patient B demonstrates that even very gentle treatments can generate perceived adverse events.
Heartfelt thanks to everyone who has shared their experiences through making reports to the AERD! POCA Tech students appreciate learning from you.