Patients must be appropriately assessed for contraindications for DN. DN should not be administered in the following circumstances or only with special precaution. These recommendations stem from the following sources [2, 13, 14]:
| 3.1 | Absolute contra-indications |
| 3.1.1 | Patients, who have needle phobia, are unwilling to have DN or are unable to give consent; |
| 3.1.2 | A patient who has had a history of abnormal reaction to DN or injection; |
| 3.1.4 | Use of DN on an area or limb where there is lymphoedema, due to the increased risk of infection; or |
| 3.1.5 | A patient who is currently taking anti-coagulant therapy or who has thrombocytopenia or other clotting disorder and where haemostasis by palpation cannot be performed following the needling procedure, for example psoas and tibialis posterior muscles. |
| 3.2 | Relative contra-indications |
These include but are not limited to the following:
| 3.2.1 | Abnormal bleeding tendencies. Caution should be taken when using DN in patients on anti-coagulant therapy or who have thrombocytopenia or other clotting disorder. If DN is utilised, light needling techniques must be used and followed by haemostasis applied by palpation after needle withdrawal; |
| 3.2.2 | Compromised immunity. Patients with a compromised immune system are more prone to infection, both local and systemic following DN. Thus these patient groups must be assessed for relative contra-indication to DN. Examples include immunocompromise from disease like blood borne disease, cancer, diabetes, human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), viral hepatitis, bacterial endocarditis, incompetent heart valves or valve replacements; |
| 3.2.3 | Vascular disease – where there is increased susceptibility to bleeding, tissue trauma and infection; |
| 3.2.4 | Lymphoedema or following lymph node removal due to increased risk of infection; |
| 3.2.5 | Diabetes mellitus – poor peripheral circulation and compromised tissue healing requires caution when considering DN. DN should be avoided in the extremities of patients with diabetic neuropathy; |
| 3.2.6 | Acute systemic infections, with or without fever, or contagious diseases; |
| 3.2.7 | Pregnancy – DN must be used with caution throughout pregnancy, especially in the first trimester due to the high incidence of spontaneous abortions that occur naturally; |
| 3.2.8 | Frail patients – ensure DN can be tolerated and that the patient does not suffer from any sensory lose in the area prior to using DN; |
| 3.2.9 | Epilepsy – the epileptic patient must be assessed and DN should be used with caution especially with unstable epilepsy. The patient must not be left unattended if DN is utilised; |
| 3.2.10 | Allergy to metals or latex – DN should be avoided due to allergic reaction, unless alternatives can be used i.e. latex free gloves; |
| 3.2.11 | Children – assent and parental/guardian consent is required. It is advisable to avoid DN in patients younger than 15 years due to their ability to understand and follow the procedure [15]. |
| 3.2.12 | Skin changes – avoid DN in areas where the skin has an infection, lesion, allergic reaction or acute inflammation. Avoid DN into haematomas due to risk of infection; |
| 3.2.13 | Patients on certain prescription medications such as significant psychiatric, anticoagulant and immunosuppressive medicines; |
| 3.2.14 | DN near surgical sites within 4 months of surgery, due to increased risk of infection; |
| 3.2.15 | Anatomic considerations – extreme caution must be utilised to avoid injuring pleura, lungs, blood vessels, nerves, organs and joints. The practitioner must ensure that their anatomical knowledge in the area is sufficient; |
| 3.2.16 | Prosthetic implants and implanted electrical devices – exercise caution and the practitioner must ensure that their anatomical knowledge in the area is sufficient; |
| 3.2.17 | Paraesthesia – sensory changes indicate that DN may not be used safely in these patients, as they will not be able to give adequate feedback thus DN should be avoided; |
| 3.2.18 | Tumours – do not DN in the area of a tumour; and |
| 3.2.19 | Avoid mucous membranes, eyes and genitals. |
