Electrical Currents for Tissue Healing (week 6)

Contraindications and Precautions

Same as general ES contraindications and precautions plus…

• May need to use lower amplitude if sensation is impaired or skin integrity is compromised

• Electrodes place in wound or on a patient with an infection are used only ONCE

• Self-adhesive electrodes can be used with one patient only

• Protective covers for ES units should to prevent spread of communicable diseases (MRSA) should be left in the patient’s room.

Electrical Stimulation can promote tissue healing by:

Applying current to the wound

Control edema

Promote transdermal delivery of medications

Galvanotaxis

The attraction of cells to an electrical charge

Wound Healing

ES promotes tissue healing by:

Attracting appropriate cell types to the area

Activating these cells by altering cell membrane function

Modifying endogenous electrical potential of the tissue

Reducing edema

Enhancing anti-microbial activity

Increasing protein synthesis and cell migration

Promoting circulation

Improving tissue oxygenation

Enhance fibroblast replication (proliferative phase)

Negative electrode (Cathode, Black)

Use it to promote healing of inflamed or infected wounds

The following are attracted to the negative electrode:

activated neutrophils

lymphocytes

platelets

mast cells

keratinocytes

fibroblasts

Positive electrode (Anode, Red)

Use it to promote healing of wounds without inflammation

The following are attracted to the positive electrode:

macrophages

epidermal cells

High-volt pulsed current – For tissue healing

HVPC is a monophasic pulsed current

One electrode is used if the electrode is directly in the wound

2+ are used if the electrodes are around the area

Electrode closest to the wound is determined based on which cells you want to attract.

Larger dispersive electrode is placed several inches away

Continuous electrical flow for 45-60 mins

Edema associated with inflammation

Negative HVPC is believed to reduce edema because the negative polarity repels negative charge serum proteins (doesn’t allow them to leave the blood vessels)

Treatment time 20-30 mins

Negative electrode is placed directly over the area with edema. Larger dispersive electrode is placed proximal to the area with edema.

ES for Edema associated with lack of muscle contraction

Reduces edema by promoting muscle contraction that compress the veins and lymphatic vessels. Should be combined with elevation and followed with compression garment.

Treatment time 20-30 mins

Look for small visible muscle contraction

Electrodes placed on the muscle around the main veins

Iontophoresis

is the transcutaneous delivery of ions into the body for therapeutic purposes using a low amplitude direct current

• The charged electrode “repels” the charge medication particle

• Iontophoresis promotes transdermal drug penetration by increasing the permeability of the skin.

What is the advantage of iontophoresis?

Does not produce gastrointestinal distress like many oral medications

Is more completely absorbed into the body

Decreased risk of infection at injection site

What is Iontophoresis used for?

Inflammation (plantar fasciitis, tendinitis, bursitis)

Calcific tendonitis

Excessive sweating

Pain

Fungal infections

Scar reduction

Dermal ulcers

how iontophoresis works

Penetration of iontophoresis is thought to be 3-20 mm

Size of the pad is selected based on the location it will be placed. The fill volume will be listed on the pad.

Dosage is described as milliamp minutes (mA-min).

• Dosage is usually 40 mA-min or 80 mA-min. Iontopatches will have dosage already designated.

The amplitude of electricity used is described as mA (milliamp). Typically 1-4 mA

There is an inverse relationship between the current amplitude and the time. (Higher amplitude = Less time)

how Iontopatch works

Battery within the electrodes uses a low voltage output so a low current (0.1- 0.3 mA) delivers meds for 1-24 hours

OR Drug delivery may be decreased because the low voltage and current because of high skin resistance.

Benefits of Iontopatch

More comfortable

Can be worn under clothes

Patient doesn’t stay in the clinic

Drug delivery might be increased because it causes less increase in local circulation (impedance)

Medication Delivery

Dexamethasone and lidocaine are the most commonly used medication with iotophoresis

Polarity of medication has to be the same as the polarity of the electrode it is placed in

Application

Clean area with soap and water (not alcohol!) before application

Current amplitude is adjusted to patient tolerance. For in-clinic use, monitor patient’s response and watch for signs of a reaction.

Do not use heat or cold with iontophoresis!!

Clean treatment site after removal

Documentation

In addition to basic ES documentation, include information about medication, active electrode, skin reaction

Acetate source

acetic acid

acetate, Dexamethsone phosphate, chloride polarity

negative

acetate indications

calcium deposits

acetate concentration

2.5-5

Dexamethsone phosphate source

DexNa2PO3

Dexamethsone phosphate indications

inflammation

Dexamethsone phosphate concentration

0.4

lidocaine source

lidocaine

lidocaine, magnesium polarity

positive

lidocaine concentration

5

lidocaine indications

local anesthetic

magnesium source

MgSO4

magnesium indications

muscle relaxant, vasodilator

chloride source

NaCl

chloride indication

sclerotic

chloride concentration

2