VCU DPT - Agents (Estim for Tissue Repair + Edema)

name some indications for estim use of tissue repair

pressure injuries

diabetic ulcers

venous ulcers

arterial ulcers

traumatic wounds

surgical wounds

burns

donor sites

evidence shows estim stimulates _________ wound size reduction and procudes _______ closed wounds

faster

more

does evidence show estim has effect on reducing wound size and closing wounds?

yes, closes them faster and closes them more

the evidence shows estims greatest effect is with ________ injuries

presssure

evidence shows that estim makes wounds close _________

at a faster rate

does evidence shows estim helps with acute wounds

yes

estim helps wound healing by upregulating _______ multiple times, and producing ________ _______ tissue

angiogenesis

organized granulation (organized bolded in slides)

t/f: evidence shows that efficacy of estim to heal wounds is inversly related o wound size and duration

true

means that more likely to heal them if the wound is smaller and acute

is monophasic current with active electrode over wound good for wound healing with estim (according to evidence)

yes

whjat is the mechanism of action for wound healing with e-stim

galvanotaxis

the cells will naturally sense electricity and follow the fields

what is galvanotaxis

cells associated with healing become charged and migrate to a specific pole of the electrical field

mechanism of action for estim to help wound healing

what is this process called:

neutrophils, macrophages, lymphocytes, keratinocytes migrate; endothelial cells elongate and reorient

healing occurs

galvanotaxis

what is result of galvanotaxis

angiogensis, protein is made, and swelling goes down

tissue heals!!!!

what are the parameters for high-vvoltage pulsed current (Twin peak monophasic)

frequency: 100 pps

duration: 4-100 msec (usually preset)

amplitude: comfortable sensory (no mm action)

duration: 45-50', 5-7x/week

- an hour every day

is there an anode and cathode with high voltage pulsed current

what does this mean

yes

there IS a net charge produced under the skin

research shows the estim is good for ____ wounds, but best for _____ wounds

all

pressure

if the electrode is on/in the wound, then the electrode there should be the.....

______________ in early stage of healing

___________ in later stage of healing

cathode (-)

anode (+)

if we are placing electrodes on EITHER SIDE of the wound, clinicians must do what with the electrodes over multiple sessions

rotate them 45-90 degrees around the edge

in early stage of healing, we want to place the ______ electrode on the wound

what are the goals of estim

cathode

help with wound inflammation, infection

in later stage of healing, we want to place the _______ electrode on the wound

what are the goals of estim

anode

debridement (aka phagocytosis, autolysis, epithelization)

which type of edema does estim work on:

actue local edema

systemic edema

acute local

with acute edema, the ________ electrode is used to help repel ____________

what is charge of both of the missing things

cathode

serum proteins

both negative

can high voltage pulsed current (twin peak monophasic) be used for edema

yes it can

helps limit onset of swelling with 24-72 hours

where do you place electrodes in estim for swelling

how should limb be positioned

very far from one another

above the heart to aid in gravity

paramters for HVPC (twin peak monophasic) with edema

Frequency:

pulse duration:

amplitude:

active electrode:

duration:

Frequency: 100-125 pps

pulse duration: 2-100 msec (preset)

amplitude: barely comfortable sensory, more so than wounds

active electrode: cathode (-) over the edema

duration: 20-45'

which ampltiude should be stronger:

wound healing or edema healing

also, say if either should be sensory or muscle

both should be sensory only

edema healing should be stronger than wound healing

can we use either HVPC (twin peak monophasic) or russian (biphasic pulsed) for edema

what is difference

HVPC: used for acute localized edema

russian: used for chronic localized edema

is there ample evidence in literature for russian/biphasic pulsed to be used for chronic edema

not a ton

what is MOA for russian biphasic pulsed to be used with chronic edema

repetitive muscle action

parameters for russian/biphasic pulsed with chronic edema control

frequency:

pullse duration:

amplitude:

on/off time:

tx duration:

frequency: 20-80 pps

duration: 100-600 msec

amplitude: tetanic contraction

on/off time: 1:1 ratio, 1-3"

duration: 10-20'

what is iontophoresis

a technique that uses direct current to deliver a drug through skin, via galvanotaxis

using direct current, chemicals build up under the skin (transdermally) and drug is delivered. what is this called

iontophoresis

with iontophoresis..

- substance needs to be _____ in nature becausr the application is ______ dependent

- the purpose is what

- what is an advantage to it

ionic, polarity

to deliver the drug in high concentration

to minimizes adverse local/systemic side effect

with iontophoresis, does it matter which is cathode and which is anode

yes

with iontophoresis, there is a "active/treatment" and "dispersive/inactive" electrodes

which one does the drug ion flow away from, and which does it flow towards

so how do we determine which one is cathode and which is anode

drug ion flows away from the active, towards the inactive

the cathode/anode placement is determined by the drugs polarity

- if it is negative, then the cathode is active (negative repels negative)

- if it is positive, then the anode is active (positive repels positive)

when using a drug with positive polarity, the ________ is used as the active electrode

when using a drug with negative polarity, the _______ is used as the active electrode

anode

cathode

with iontophoresis, what are the three main mechanisms of ion movement into tissues

1) repulsion of like charges

2) electroporation (skin gets more porous as estim is applied to it)

3) electroosmosis

what is electroosmosis, and how can it help with iontophoresis

it is "volume flow"

the Na and H2O are attracted to cathode normally

the Cl is attracted to anode naturally

drugs follow this flow and get all mixed up

which does the body help assist with:

ions delivered from anode or cathode

anode

the body assists ions delivered from the ________, where as ions delivered from the _______ need a larger current

anode (+)

cathode (-)

does iontophoresis help with lateral epicondylitis or insertional achilles tendonitis, according to evidence

LE: good early, but long term same

AT: may give some relief, but long term no difference

what are the components of iontophoreitc drug delivery system

2 leads and 2 electrodes

- one anode

- one cathode

anode's charge is ______, and its color is ________

cathode's charge is _______, and its color is _______

anode (+), red

cathode (-), black

what two things must a therpaist do with iontophoretic drug delivery system

they must

- know polarity of ion/drug being used

- ensure good conductivity

with iontophoresis, a therpaist MUST know __________, and ensure ______

know the drug's polarity

ensure good conductivity

when placing electrodes with iontophoresis:

- where does active electrode go

- where does inactive electrode go

- what happens the closer the placement is

active goes over treatment site

inactive goes over a muscle belly distal to the active site

the current will penetrate less deep (more superficially) into the tissue

how far can iontophoresis penetrate at max

1.7 cm

if a patient ices before iontophoresis delivery, why may this be helpful

the local vasoconstriction helps keep the drug in desired area

with ionotophoresis,

Dosage (mA-min) = _________ x __________

current (mA) x duration (min)

what is a typical clinical dosage for iontophoresis

20-80 mA-min (0.10-4 mA depending on patient tolerance)

what is the common target for dosage of iontophoresis

40 min-mA

doing iontophoresis with the patient, you want to hit the common target 40 min-mA, but the patient complains that it is too strong. what can you do to ensure thisd dosage target is hit

you have to decrease amplitude bc patient says so, but increase the time

t/f: evidence is very clear on the optimal iontophoresis parameters

false

evidence is not clear regarding optimal paramters

when a patient has a home use iontophoresis device, thecurrent is usually around _______ while the duration can be how long

less than 1 mA

up to 24 hours

what is a good way for a patient to take off iontophoresis electrode/unit/patch at home to avoid skin damage

do it in the shower (will be damp)

how do we calculate current density under the electrode

give units too

current ampltiude/conductive surface area

CD = mA/cm squared

what is maximum safe current density for both

anode

cathode

anode: 1.0 mA/cm squared

cathode: 0.5 mA/cm squared

why is the maximum safe current density lower for cathode than anode

because with cathode, sodium hydroxide forms under the cathode and can cause skin damage

with cathode, the safe current density is lower than the anode because _________ can form under the electrode and cause skin damage

sodium hydroxide

give the charge of the following meds:

dexamethasome

acetic acid

lidocaine

sallicylates

iodine

zinc oxide

lidocaine and zinc oxide are positive

rest are negative

tell me the indication for the following drugs

dexamethasome

acetic acid

lidocaine

sallicylates

iodine

zinc oxide

dexamethasome: inflammation

acetic acid: calficic tendonitis

lidocaine: soft tisssue pain + inflammation

sallicylates: muscle + joint pain

iodine: adhesive capsulitis, soft tissue adhesions

zinc oxide: skin ulcers

for inflammation, what two drugs can iontophoresis be used with

dexamethasome

lidocaine

what is the effect of dexamethasome

anti inflammatory

what is the effect of acetic acid

increase the solubility of calcium deposits

what is the effect of lidocaine

local anesthetic

what is effect of salicytates

analgesic, anti inflammatory

what is effect of iodine

scleorlytic

what is effect of zinc oxide

antispetic, can help tissue heal

use ________ for inflammation/ "-itis"

dexamethasome

how do you clean skin for iontophoresis

ALCOHOL PAD

must must must be this

to clean skin for TENS we use _______ but for iontophoresis we use _____

soap and water

alcohol pad

place the ______ electrode over area to be treated, and the _______ electrode over the muscle belly (ionto)

active

inactive

how far away should the inactive electrode be from the active electrode (ionto)

at least 2x as wide as electrode itself is

the polairty is determined by the ______ (ionto)

drug

what should the current's amplitude be

what is the MAX

(ionto)

to patient comfort

no greater than 4 mA to avoid any burns

what is ionto treatment time detemrined by

it is the dosage, and then current from there

we are given dosage and find current patient is cool with, and then the treatment time is whatever fits into that equation

dosage = treatment time * current

t/f: you should closely inspect the skin after treatment

true true true true

what do patients usually descirbe ionto as feeling like

stinnging, ant bites

this is NORMAL

are patients at a greater risk of skin irritations with ionto?

if yes, why?

if no, what estim condition is at higher risk?

yes

the use of DIRECT CURRENT, not the drug itself

if the patient has some stinging with ionto and some redness, is this an issue?

when would it become an issue

it is normal

if there are blisters or pain lasts more than 1-2 hours

why are patients at greater risk of skin irritation with ionto

the DC

not the drug

your patient is getting ionto. they say it hurts like stinging, and ask is this normal. what do you say?

they also remark that the drug they are using must be really painful and strong because it hurts. what is your response?

this is normal

no, it is the direct current causing reaction not the drug

with ionto, where is skin irritation most common

unde the ACTIVE electrode

ANODE:

attracts _______

forms _______

the reaction is ________

the process is ______

the effect is the skin ______

attracts Cl-

forms HCl

the reaction is acidic (CAB)

the process is slcerotic

the effect is the skin hardens

CATHODE:

attracts ______

forms ______

the reaction is ______

the process is _______

the effect is the skin ______

attracts Na+

forms NaOH

the reaction is basic

the process is sclerolytic

the effect is the skin softens

some ionto contraindications

allergy to drug

cardiac pacemarker

tumor

unstable arrhytmia

over the face and neck and carotid sinus and chest

active DVT

infection

over damaged skin unless for healing

oregnancy

some ionto precautions include

impaired sensation

impaired mentation

impaired ciculation

skin disease

neuropathy

epiphysis

cardiac disease