Hong Kong Hospital Authority PTCOC

Operation Guideline
For
Acupuncture by Physiotherapists

July 2009 Revision

 Forward
This revised operation guideline for acupuncture by physiotherapists was prepared by
the Acupuncture Working Group# of PTCOC, Hong Kong Hospital Authority. The
revision focuses on updates of infection control procedures for acupuncture practice
by physiotherapists.

This guideline was designed to be used as a guide to acupuncture practice by

physiotherapists working in Hong Kong Hospital Authority.

The content of this guideline was based on epidemiological and other research
evidence available in international literature and guidelines, supplemented where
necessary by the consensus opinion of the Acupuncture Working Group of PTCOC,
Hong Kong Hospital Authority.

#
Composition of the Acupuncture Working Group, PTCOC:

Chairman
Mr. Eric LAW Yuen Tung SPT, POH

Secretary
Ms. Cecilia KWOK Yee Fung PTI, RHTSK

Members
Mr. Andy CHAN Chi Ming SPT, HKBH
Mr. Anthony LAU Wing Keung DM(PT), AHNH
Mr. Alex WONG Kam Wah PTI, PYNEH
Mr. Chris WONG Hiu Po PTI, TWH
Mr. Frank LAU Wai Kwong PTII, HHH
Mr. Kenny YUEN Chi Chung PTI, DTRC
Mr. Raymond TSANG Chi Chung SPT, QMH
Mr. Simon HUI Wai Chi SPT, KCH
Mr. Steward CHEUNG Ying Kit SPT, KWH
Mr. Tony CHIU Hiu Fai PTI, UCH
 Introduction
Acupuncture has been embraced as one of the treatment modalities within the scope of
Physiotherapy practice in some hospitals in Hong Kong since 1980’s. According to
the Chinese Medicine Ordinance 108(3), the Hong Kong Government SAR has
legitimized the practice of acupuncture, bearing distinguishable differences from that
based on Traditional Chinese Medicine, by registered physiotherapists in Hong Kong.
To uphold the standard of local physiotherapists practicing acupuncture , there is an
accreditation procedure by our professional body – the Hong Kong Physiotherapy
Association , which has set its standards in line with the international benchmark- the
International Acupuncture Association of Physical Therapists (IAAPT).

In response to the increasing demand on acupuncture by patients, acupuncture has

been incorporated as one of the therapeutic interventions by local physiotherapists and
their counterparts worldwide including United Kingdom, Canada and Australia.
Thorough Physiotherapy Assessment, a procedure by which collection of relevant
information and quantified data, is conducted prior to treatment. A problem list and
physical diagnosis utilizing clinical reasoning process based on Western Medicine
will then be formulated. Treatment modalities including acupuncture, targeted towards
resolving the clinical problems, are explained and implemented to the patient.
Parameters of acupuncture are selected based on quality medical literature protocols
and good knowledge of human anatomy, neuroanatomy, neurophysiology in pain and
motor control and related information on physiology and pathology of the conditions
treated. All evaluative and therapeutic interventions should be documented according
to the “Operation Guidelines for Physiotherapists Practicing Acupuncture in Hospital
Authority.”

In benchmarking with the international standard set by the International Acupuncture

Association of Physical Therapists (IAAPT) under the World Confederation for
Physical Therapy (WCPT), which is a member organization of the World Health
Organization, this “Operation Guidelines for Physiotherapists Practicing Acupuncture
in Hospital Authority” is formulated to progress and uphold the quality and standard
of physiotherapy service to all patients in guarding their interest & benefit. All
physiotherapists practicing acupuncture in Hospital Authority have to abide strictly the
“Code of Practice” issued by the Physiotherapists Board of Hong Kong. To match
with the pace of the rapid advancement of modern medicine and technology, these
operation guidelines are subjected to review by the Central Coordinating Committee
(Physiotherapy) of the Hospital Authority in line with the contemporary standards of
the IAAPT and the Hong Kong Physiotherapy Association.
 CONTENT

1. Standards of Practice of Acupuncture by Physiotherapists in p.5

Hospital Authority

2. Formulation of Acupuncture Treatment Plan p.6

3. Contraindications and Precautions of Acupuncture p.7-10

4. Warnings given to patients prior to Acupuncture Treatment p.11

5. Acupuncture Infection Control Procedure p.12-14

6. Prevention of Needle Accidents & Adverse Reaction p.15-18

7. Management of Possible Complications p.19-21

8. Application of Electro-acupuncture (EA) p.22-23

9. Application of Auricular Acupuncture, Press Needle and Bead p.24-25

10 Patient Information for Acupuncture p.26

11 接受針刺治療病人須知 p.27

12. Acupuncture Treatment Record Sheet p.28

13. Reference p.29-31

 Standards of Practice of Acupuncture by
Physiotherapists in Hospital Authority

All registered physiotherapists who practice acupuncture should:-

1. Have successfully completed a training program in acupuncture AND be

accredited by the Hong Kong Physiotherapy Association Ltd.

2. Confine their practice of acupuncture to the treatment of conditions within their

scope of practice of physiotherapists in Hong Kong.

3. Apply acupuncture as one of the treatment modalities of the physiotherapy

profession.

4. Facilitate exchange of information by using common codes and terminology, i.e.

WHO nomenclature.

5. Maintain a high standard of documentation to describe acupuncture procedures,

including explanation to patients, list of combination of points selected, method of
manipulation, duration and frequency of application.

6. Comply with safe acupuncture practice by following recommendations in this

guideline.

7. Comply with standards of infection control procedures as recommended in this

guideline.

8. Follow the Code of Practice issued by the Physiotherapists Board of Hong Kong.

5
 Formulation of Acupuncture Treatment Plan
A. Assessment
1. Subjective and objective information from patients, as well as medical
investigation, patient’s personal particulars are collected.
2. Data from the assessment should be documented as clinical records.
3. Data is analyzed.
4. Area and type of acupuncture intervention are identified.

B. Intervention Plan
1. Goal for acupuncture intervention should be set.
2. Problems, goals and intervention program (including acupuncture and other
appropriate modalities) should be discussed with patients.
3. Contra-indications and precautions for acupuncture and all intervention
modalities selected should be noted. A checklist prior to implementation of
acupuncture is advised. See Appendix I for reference.
4. Verbal consent for acupuncture treatment must be obtained from patients.
5. Intervention plan and time frame of therapy are designed.
6. Acupuncture intervention plan, as aligned with the holistic treatment plan,
is documented.

C. Implementation of Acupuncture Treatment

1. All safety precautions are taken.
2. Warning regarding inappropriate responses should be given to patients.
3. Hygiene and sterilization procedures for both patients and therapists are
followed.
4. Standards of waste disposal and handling of blood and body fluid are
followed.
5. On going reassessments are needed and appropriate changes will be made if
so required.
6. Records describing acupuncture points, penetration depth, angle of insertion,
acupuncture procedures, treatment dosage, and if any electro-acupuncture
or special needle manipulation has been applied, are documented to
facilitate communication with internal and external customers. Common
codes in WHO nomenclature are used to enable exchange of information
internationally. Appendix II is a recording form for reference.

6
 Contra-indications and Precautions of Acupuncture

A good knowledge of anatomy is essential in order to avoid structural damages

such as nerves, organs or arteries.

A. Prohibited Areas for Needling

The following areas should be avoided at all times.

1. Scalp area of infants before the fontanelle has closed
2. Nipples and breast tissues
3. Umbilicus
4. External genitalia
5. Eye balls

B. General Precautions

1. Patients with uncontrolled movement are not suitable for acupuncture.

2. Patients allergic to metals may not be suitable for acupuncture without
medical clearance.

C. Special Precautions

1. Dangerous or vulnerable points which may lead to damage -

Certain useful points which are potentially dangerous and therefore require
special attention in their use. For example, these apply to:

a. Orbit of eye:
B1 ( Jingming 睛明), medial orbit
S1 ( Chengqi 承泣), mid-lower orbit
Ex-HN4 (Yuyao 魚腰), mid-eyebrow

b. Certain neck points:

CV22 (Tiantu 天突), in front of trachea
LI 18 (Futu 扶突), side of neck over great vessels
SI 17 (Tianrong 天容), side of neck near baroreceptors
GV 15 ( Yamen 啞門), over spinal cord
GV 16 ( Fengfu 風府), over brain stem

7
c. Points over lung tissues unprotected by bone or cartilage:
L 1 (Zhongfu 中府), front of upper lung
G 21 ( Jianjing 肩井), apex of lung
B 11 ( Dazhu 大杼), back of upper lung
Liv 14 ( Qimen 期門), anterior of lung

d. Points over small nerves in the region of the elbow to fingers :-

SI 8 (Xiaohai 小海)
H 3 (Shaohai 少海)
H 7 (Shenmen 神門)

e. Points near arteries :-

S 9 (Renying 人迎), near carotid artery in anterior neck
S 12 (Quepen 缺盆), above clavicle in neck
SP 11 (Jimen 箕門), near femoral artery at inner thigh
SP12 (Chongmen 沖門), near femoral artery at groin region
L 9 (Taiyuan 太淵), on radial artery at radial side of wrist

f. Point over gallbladder :-

Right S 21 (Liangmen 梁門), lies over gall bladder

g. CV 17 (Ren 17, Danzhong 膻中), a small portion of population may

have a hole in the sternum;
SI 11 (Tianzong 天宗), a small portion of population may have a hole
in the scapula

h. Liv 3 (Taichong 太沖), hypertensive patients may suffer from a rapid

drop of BP

i. Ah Shi points close to vulnerable structures

j. Avoid needling certain pathological sites e.g. varicose veins;

inflammatory areas; malignant tumours; areas of unhealthy skin

k. Avoid needling lower GV ( Governor Vessel ) Meridian points in the

presence of Occult spinal bifida.

l. Avoid needling deep and perpendicularly on points of the chest,

hypochondria and spine.

8
2. Pregnant patients-Avoid acupuncture in the first trimester of pregnancy as
needling may cause a “miscarriage”, or in the last 3 months as it may cause
premature labour. Also to avoid points that are considered especially likely to
disturb a pregnancy. e.g.
a. LI 4 (Hegu 合谷)
SP 6 (Sanyinjiao 三陰交)
K 3 ( Taixi 太溪)
B 60 (Kunlun 昆侖)
B 67 (Zhiyin 至陰)
b. points over lower abdomen
c. ear points related to endocrine and genito-urinary system
d. scalp points for genital and motor sensory areas
e. strong electro-stimulation to acupuncture points.

3. Diabetics patients- Care should be taken when needling diabetic patients because
of the danger of poor peripheral circulation and the effect of some points on
blood sugar level.

4. Frail Patients- Patients with a weak constitution after prolonged chronic illness
may tolerate acupuncture poorly. Strong manipulation is not recommended.

5. Active/Powered-Implant Patients- Patients with active/powered implants such as :

cardiac pacemakers/defibrillators, stimulation/sensing electrodes, implantable
drug pumps and neurostimulators, should not be given electro-acupuncture.

6. Confused Patients- Great care must be taken with patients who are unable to
understand the acupuncture procedure.

7. Children- Parental consent must be obtained for treatment of children.

8. Bleeding disorders:-
a. naturally occurring haemorrhagic diseases like haemophilia, Von
Willebrands
b. drug-induced bleeding, like warfarin
c. apply pressure on each point on removing needles

9. Drugs- Patients receiving drug treatment for certain diseases may suffer
complications due to over-correcting of that condition by the homeostatic action
acupuncture eg. patients with high blood pressure or diabetes.

9
10. When Sensation of acupuncture cannot be obtained at a conservative needle
depth, let the needle rest and allow Sensation of acupuncture to come to the
needle over time.

11. Acupuncture should not be inserted in a limb with lymphoedematous swelling.

Broken skin is a source of potential infection and cellulitis, and the patient could
continue to ooze fluid from the sites of needle insertion.

10
 Warnings Given to Patients Prior to Acupuncture
Treatment

1. In the process of acupuncture treatment, there may be a very mild

pain/discomfort during insertion of needles.
2. The normal sensation during the retention of needles is soreness, heaviness /
fullness, local/ radiating paraesthesia and/ or warmth.
3. Do not move or contract muscles over the treatment areas.
4. Do not fall asleep.

11
 Acupuncture Infection Control Procedure

A. Practitioner Preparation

1. Practitioners should wash hands with liquid soap and water, and thoroughly
pat dry hands before and after acupuncture application to patients.

2. Any cut/breaks in skin should be covered with water-proof dressing or sterile

disposable glove worn.

3. Immediately before needle insertion, practitioner should wipe their hands

again with approved disinfectant hand-rub such as those containing 70%-80%
w/w ethanol.

B. Patients’ skin preparation

B.1 For patients with normal immune system

1. The patient’s skin should be clean and free from cut, wound and infection.

2. The patients’skin should be inspected for dirt and grease. If skin is dirty, oily or
sweaty, it should be washed with warm water and liquid soap, rinsed and dried
before a skin disinfectant is applied. Dirty skin may inactivate the skin
disinfectant.

3. The needling site must be disinfected prior to acupuncture using disinfectant

such as 70-80% ethanol, 60-70% isopropanol, 0.5-1% w/v chlorhexidine or
povidone-iodine.

[Note: all practitioners must check for iodine allergy if using disinfectant
containing iodine.]

4. Individual pre-packaged sterile disinfectant wipes such as alcohol wipes are

recommended.

5. Disinfectant should be left on the patient’s skin for acupuncture for at least 1
minutes and then allowed to dry, before commencing acupuncture. The
patient’s skin should not be touched after skin disinfection.

12
B.2 For patients with deficiency in immune system or when needling into a
joint space

5. For patients who have a deficiency in their immune systems, or when needling
into a joint space, a disinfectant such as povidone iodine or 0.5-1.0 % w/v
chlorhexidine in alcohol should be used. The disinfectant should be left on the
skin for a minimum time of 1 minute and then allowed to dry.

[Note: all practitioners must check for iodine allergy. For those patients
allergic to iodine, chlorhexidine in alcohol is suitable as a substitute.]

C. Needle Insertion

1. Sterile, single-use, disposable acupuncture needles with guide-tubes are

recommended.

2. Ensure the portion of the needle to penetrate the skin does not come into
contact with the bare fingers of the practitioner, or any non-sterile surface.

3. The number of needles inserted must be documented

D. Needle Manipulation

1. Manipulate needle using the handle of the needle. Avoid touching the shaft of
the needle.

2. In the case of long needles, a sterile glove may be used to grasp the top of the
needle shafts for insertion and/or manipulation.

E. Needle Removal

1. Practitioners must wash their hands with liquid soap and water and dry hands.
Use of approved disinfectant hand-rub is an alternative for hand hygiene if the
hands are not soiled and are clean.

2. Withdraw needle by grasping needle handle, using a sterile, dry swab/cotton

wool ball to apply pressure to the insertion point to prevent bleeding.

13
3. Used needles and swab/cotton wool balls must be disposed into an approved
sharps disposal container immediately.

4. It is important to document the number of the needles removed and check

against the number of needles inserted.

5. Therapists should thoroughly wash their hands with liquid soap and water or
rub their hands in approved disinfectant hand-rub at the end of the treatment as
a routine infection control procedure to reduce the risk of cross-infection.

F. The Environment

1. The treatment area should be clean and with washing facilities near at hand.

2. Wet surfaces must be disinfected regularly.

3. Linen contaminated with blood and other body fluids should be treated with
hypochlorite solution before laundering.

G. Handling of Blood and Body Fluid

1. Care must be taken to avoid contact with patients’ blood and body fluid.
Should bleeding occur, a dry cotton wool ball should be used to absorb it. The
used cotton wool ball should be put into an appropriate container marked
‘Contaminated Material’ and disposed of according to the Hospital Authority
policy and guideline.

14
 Prevention of needle accidents & adverse reactions

Possible Needle
Accidents or Adverse Possible causes Recommended Preventive Measures
Reactions

1.Structural Injury
Unskillful needle
Good knowledge in body anatomy

including puncture to insertion and
Point palpation prior to needle insertion
vital structures manipulation
Skillful needle insertion and

Excessive appropriate manipulation
stimulation /
Avoid puncture blood vessels, nerves
manipulation and internal organs by altering the
direction and depth of needle insertion

Selection of alternative points

Using appropriate needles

2. Pain during needle
Blunt, hooked or
Check needle before needle insertion
insertion thick needles
Use quality needles

Highly sensitive
Use needle of appropriate size
patients
Full explanation and assurance to
patient prior to treatment

3. Pain after needle
Needle entwined
Avoid excessive manipulation

Insertion with fibrous tissue
Treat in a comfortable, relaxed and
during supported position
manipulation
Instruct patient not to move

Needle curves during treatment
while patient
moves

4. Pain after needle
Excessive
Avoid excessive/ prolonged

withdraw stimulation
Stimulation

15
 Possible Needle
Accidents & Adverse Possible Causes Recommended Preventive Measures
Reactions

5. Formation of
Excessive
Avoid puncturing blood vessels

haematoma after manipulation/
Press puncture site immediately
treatment stimulation after the needle is withdrawn
with a sterilized dry cotton wool
ball/ cotton bud.

6. Fainting during /
Nervous
Full explanation before treatment

after treatment apprehension
Treat in a comfortable and relaxed

Tiredness position

Hunger
Minimize the number of needles

General weakness especially in the first treatment

Severe diarrhea session

After profuse
Avoid acupuncture for patients
sweating with fatigue, severe thirst and

Excessive hunger
stimulation with
Avoid acupuncture for frail
needles patients / unstable medical
condition

Use gentle stimulation especially
in the first treatment session

7. Stuck needle
Muscle spasm
Treat in a comfortable , relaxed and

Change of supported position
position after
Avoid puncture muscle tendons
needle insertion Proper manipulation

Entanglement of
Avoid unnecessary retention of
needle in fibrous needle
tissue during
manual
stimulation /
improper
manipulation

Prolonged
retention of needle

16
 Possible Needle
Accidents or Adverse Possible causes Recommended Preventive Measures
Reactions

8. Bent needle
Too forceful or
Skilled needle manipulation

rapid
manipulation
Good knowledge in body

Needle strike hard anatomy
tissues
Treat in a comfortable , relaxed and

Sudden change of supported position
posture after
Instruct patient not to move
needle insertion during treatment

Needling area should be

Collision of protected from external force
needle handle
with external
force
9. Broken needle`
Poor needle
Use quality needles
quality
Check needle before use

Sudden change of
Do not insert needle fully up to
patient posture shaft / handle junction

Treat in a comfortable , relaxed and
supported position

Instruct patient not to move
during treatment
10. Drowsiness
Prolonged
Minimize the number of needles
retention of
Avoid prolonged retention of
needles needles

Excessive
Minimize stimulation
stimulation

17
 Possible Needle
Accidents or Adverse Possible Causes Recommended Preventive Measures
Reactions
11. Needle stick`
Improper
Use needle guide to facilitate
Injury management of needle insertion
needle
Count number of needles after insertion
and on removal of needles

Use a gloved hand to hold the cotton
ball or use a cotton bud to assist to
remove the needles

All used needles should be
directly discarded in a sharps
container clearly marked
"danger- contaminated needles"

Locate sharps containers in close
proximity to treatment table, and
secure them to a wall or
horizontal surface.

Replace sharps containers when they
are more than 2/3 full.

18
 Management of Possible Complications

Possible complications Suggested Management

1. Pain caused by needle inserted deep
Adjust the depth and direction of needle
into tissues and hitting pain receptor insertion
nerve fibers

2. Pain caused by needle entwined with
Gently rotate the needle back and forth
fibrous tissue during manipulation until the fiber is released

3. Pain caused by curved needle after the
Resume the original position , then
patient moved withdraw the needle carefully

4. Pain caused by unskilled manipulation
Massage the affected area gently with clean
or excessive stimulation gauze for a while after withdrawal of
needle

5. Mild Haematoma
Haematoma may resolve by itself.

Reassure patient.

Detail documentation on location and size
of haematoma.

6. Large Haematoma
Apply a cold compression to stop bleeding.

Then after the acute phase, apply a warm
compression to help disperse and absorb
local stasis of blood.

Seek medical advice as indicated.

Document details on location and size,
follow-up management
7. Fainting
Remove needles.

Lie patient down with legs raised , if
indicated.

Measure & monitor vital signs.

Reassure patient and seek medical advice
as indicated.

19
 Possible complications Suggested Management

8. Bent needle
Relax the body part and resume

original position if change of
position is the cause.

Reassure the patient

Remove the needle slowly following
the course of the bend. NEVER REMOVE
WITH FORCE.

Seek medical advice as indicated.

9. Stuck Needle
Relax patient and alter position

slightly.

Reassure patient

EITHER
Massage skin around the needle lightly,
leave a while, then remove needle.
OR

Put 1-2 needles around the stuck needle and
then gently remove the stuck needle.

10. Broken Needle
Reassure patient.

Keep position and do not move.

If the broken needle is exposed from the
skin, remove it with forceps.

If the broken part is leveled with skin, give a
light pressure around the surrounding skin to
expose the tip, then remove the broken
needle.

If surgical removal is the choice,mark the
skin with a radio opaque object e.g.
paperclip stuck to skin. Refer patient to
Emergency Department immediately for
further management.

20
 Possible complications Suggested Management

11. Local infection
Refer for medical management.

12. Pneumothorax
Refer for urgent medical management

IMMEDIATELY.

13. Needle Stick Injury
Encourage bleeding and wash wound well.

Blood test for Hepatitis, HIV status for both
therapist and patient.

21
 Application of Electro-acupuncture (EA)

A. Equipment
1. You must use a biphasic stimulator, designed for EA. Direct current
must be avoided in order to prevent polarization of the needle due to
electrolysis.
2. Do not use needles with a plastic handle.

B. Application Procedure
1. Place each pair of needles in acupuncture points according to:
a. type of stimulation
b. area of pain
c. distal points
d. meridians
2. Select needles to be paired up for EA.
3. Do not apply electrodes circuiting across the heart.
4. Minimum distance between two needles in a pair should be 3-5cm
while maximum distance be 20-30cm.
5. Insert needles to the selected acupuncture points till acupuncture
sensations are achieved.
6. Connect the wires to the handles.
7. Turn on the device and raise the intensity slowly till muscle
contraction (for use with Low Frequency) or paraesthesia (for use
with high frequency) is reported from the patient.
8. Set Treatment time e.g. 20-30 minutes.
9. Turn down intensity and switch off the device before disconnect from
the patient.

C. Choice of Parameters
1. Low Frequency(LF), 2-10Hz: stimulate the A-delta fibres, give
release of endogenous opioids, endorphins and produce muscle
contraction.
2. High Frequency(HF), 80-100Hz: stimulate the A-beta fibres, block
pain on segmental level through “pain gate mechanism”, it produces
paraesthesia.
3. Combination of LF and HF, e.g.2/15Hz (a continuous 2 Hz frequency
along with intervening but intermittent pulse trains of 15 Hz):
stimulate A-delta fibres, give release of maximum endogenous

22
 opioids, endorphins and enkaphelins.
4. Distal points: often LF (2/4Hz), the main issue for using distal points
is to prolong the treatment effect by activating central descending
inhibitory pathways.
5. HF in area where no muscle-contractions are possible, e.g. around
joints.
6. HF in patient with spasicity.

23
 Application of
Auricular Acupuncture Press Needle and Bead

A. Auricular Acupuncture

1. Select the acupuncture points and mark with pressure, or detect the most tender sites
with the point finder.

2. Clean the skin with warm water and liquid soap to remove the natural oil and dirt
from skin and dry well.

3. The needling site must be disinfected prior to acupuncture using disinfectant such as
70-80% ethanol, 60-70% isopropanol, 0.5-1.0% w/v chlorhexidine in alcohol or
povidone-iodine.

4. The disinfectant should be left on the skin for at least 1 minute and then allowed to
dry.

5. If acupuncture needles are inserted into the cartilage of the ear, the skin should be
prepared by using disinfectant such as povidone-iodine or 0.5-1.0% w/v
chlorhexidine in alcohol.

6. The disinfectant should be left on skin for at least 1 minute and then allowed to dry.

[Note: all practitioners must check for iodine allergy if using disinfectant containing
iodine. For those patient allergic to iodine, chlorhexidine in alcohol is suitable as a
substitute.]

7. Use small sterile disposable needles with 1/2 to 1 inch, either ipsilaterally or
bilaterally.

8. Insert needle quickly through the skin.

9. Leave in place for 20-30 minutes for maximal effect.

10. Electroacupuncture may be applied.

11. Use light weight clips to connect to needles in pair. Tape it if necessary.

24
 B. Semi-permanent Press Needle
(It is about 1.5mm long small needle with a head like a thumbtack)

1. Clean the skin with warm water and liquid soap to remove the natural oil and dirt
from skin and dry well.

2. The needling site must be disinfected prior to acupuncture using disinfectant such as
70-80% ethanol, 60-70% isopropanol, 0.5-1.0% w/v chlorhexidine or
povidone-iodine.

3. The disinfectant should be left on the skin for at least 1 minute and then allowed to
dry.

4. If acupuncture needles are inserted into the cartilage of the ear, the skin should be
prepared by using disinfectant such as povidone-iodine or 0.5-1.0% w/v
chlorhexidine in alcohol.

5. The disinfectant should be left on the skin for at least 1 minute and then allowed to
dry.

[Note: all practitioners must check for iodine allergy if using disinfectant containing
iodine. For those patients allergic to iodine, chlorhexidine in alcohol is suitable as a
substitute.]

6. Press the needle quickly through the skin.

7. Cover and hold the needle in place with plastic skin (flexible collodion)

8. Needles can be retained in place for several days.

9. If there are signs and symptoms of infection of the needling site(s), prompt medical
advice and treatment should be sought.

C. Semi-permeable Bead

Instead of using the press needles, small ballbearing –like objects can be used. They are
stuck over the site with an adhesive tape patch. Patients can apply pressure over the
beads to stimulate the points.

25
 Patient Information for Acupuncture

1. Please inform your physiotherapist if you have any of the following conditions:
 pregnancy
 menstruation
 on Warfarin or other similar medications
 haemophilia
 diabetes mellitus
 hypertension
 epilepsy
 pulmonary tuberculosis
 hepatitis
 infectious diseases
 cardiac pacemaker
 deep brain stimulator
 other electronic implants
2. Please keep the body parts for treatment clean and free of any ointment before
acupuncture.
3. Avoid being hungry, thirsty and unduly tired before acupuncture.
4. Avoid wearing tight outfits and metal accessories over the body parts for
acupuncture.
5. During acupuncture, please relaxed and do not change position or move.
6. Please empty your bladder before acupuncture. This is especially important if
acupuncture is applied to the lower abdominal region.
7. Do not touch the needles or other acupuncture equipment.
8. Do not fall asleep during acupuncture.
9. During acupuncture, you may have one or more of the following sensations:
soreness, heaviness, fullness, local or radiating paraesthesia, and warmth. These
sensations are normal. Such sensations may last for a period of time after
treatment.
10. After acupuncture, there may be mild bruising over the treatment area, it will subside
gradually.
11. If you have any discomfort during acupuncture, please inform your
physiotherapist immediately.
12. Please consult your physiotherapist for any queries.

26
 接受針刺治療病人
病人須知
接受針刺治療病人須知

1. 病人如有任何以下疾病或情況，請立刻通知物理治療師：
˙ 懷孕
˙ 月經
˙ 正服食薄血丸或同類抗凝血藥物
˙ 血友病
˙ 糖尿病
˙ 高血壓
˙ 羊癇症
˙ 肺結核
˙ 肝炎
˙ 傳染病
˙ 裝有心臟起搏器
˙ 裝有腦部深層刺激儀器
˙ 裝有其他電子植入儀器

2. 每次應診前，請保持身體清潔，及避免在針刺治療部位塗上任何
藥膏。
3. 接受針刺治療前，應避免過飢、口渴或過累。
4. 請勿穿著緊身衣服或於治療部位配帶任何金屬物件。
5. 針刺治療時，請放鬆，切勿轉換姿勢或移動針刺部位。
6. 請於治療前如廁，這對於下腹部位的針刺治療尤其重要。
7. 切勿觸摸針或針刺用品及儀器。
8. 針刺治療時請保持清醒，切勿睡著。
9. 針刺治療時，可能會感到：酸 / 重 / 脹 / 麻 / 微溫。這是正常
針感，可能會於治療後持續一段時間。
10. 針刺治療後，針刺部位可能會有微瘀，一般會於數天後消失。
11. 於針刺治療時如感到不適，請立即通知物理治療師。
12. 如有任何疑問，可向物理治療師查詢。

27
 _______________________ Hospital

Physiotherapy Department Patient Gum Label

Acupuncture Treatment Record Sheet

Physiotherapist I/C: _______________________

Contraindication checked: □ Yes Treatment explained: □ Yes
Information sheet read: □ Yes Verbal consent obtained: □ Yes

Acupuncture Details Date

Acu-points Selected Penetration
Disinfectant
WHO Depth Insertion
Applied*
Nomenclature (inch/cm) Angle#
1/ L/R A/B/C/D P/O/H

2/ L/R A/B/C/D P/O/H

3/ L/R A/B/C/D P/O/H

4/ L/R A/B/C/D P/O/H

5/ L/R A/B/C/D P/O/H

6/ L/R A/B/C/D P/O/H

7/ L/R A/B/C/D P/O/H

8/ L/R A/B/C/D P/O/H

9/ L/R A/B/C/D P/O/H

10/ L/R A/B/C/D P/O/H

Total number of needles inserted

Total number of needles removed

Warning: remain relax, keep in position, report discomfort

Electrical Stimulation Protocol Frequency (Hz)

Duration (Min)

Adverse Response: F – Fainting H – Haematoma

S – Stuck needle B – Broken needle
O – Others

Physiotherapist Signature

*Notes: Disinfectant: A – 70-80% ethanol B – 60-70% isopropanol

C – 0.5-1% w/v chlorhexidine D – povidone-iodine (iodine allergy checked)
#Notes: Insertion angle: P – perpendicular O – Oblique H – Horizontal

28
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