Acupuncture techniqueSIR-Halvorsen and colleagues (May 6, p 1175) report a fatal case of cardiac tamponade in a woman with a congenital sternal foramen through which an acupuncture needle passed.The acupuncture point used was Ren 17 (Shanzhong or Tanzhong)' at the level of fifth intercostal space in mid-sternum.Acupuncture textbooks show that at Ren 17 the needle must be inserted horizontally or parallel to the sternum, never perpendicularly, and pointed upward or laterally.2°3The accident described seems therefore to have been avoidable.The Brazilian General Medical Council considers acupuncture as a medical act.Even if a doctor does not know about a congenital sternal foramen, commonsense and knowledge of the thickness of the chest wall and the depth of the needle insertion should guarantee safety at this acupuncture point.
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Morris et al. (1995) studied this question.