7 ES for Tissue Repair Edema Bionto

what are indications for estim for tissue repair?

pressure injuries

diabetic ulcers

venous statis ulcers

arterial ulcers

traumatic wounds

surgical wounds

burns

donor sites

according to literature, ionto has a 144% great healing rate in what kind of injuries?

pressure injuries

according to literature, ionto up-regulated ______ over multiple time points and produced _______?

angiogenesis

organized granulation tissue

T/F venous or arterial ulcers benefited more from unidirectional high voltage pulsed current than pressure ulcers

F

what is galvanotaxis?

cells associated with tissue healing are charged and migrate to a specific pole of an electrical field → healing

HVPC parameters (High Voltage Pulsed Current)

aka twin-peak monophasic

pulse frequency: 100 pps

pulse duration: 4-100 msec (often preset)

amplitude: comfortable sensory

duration: 45-60 min, 5-7 times/week

in early stages of healing, is a cathode or anode used? what is primary treatment for?

cathode (-)

wound inflammation, infection

in later stages of healing is cathode or anode used? what is primary treatment for?

anode (+)

debridement (phagocytosis, autolysis), epithelialization

what is important to note when doing HVPC treatment?

when placing electrodes on side of wound, rotate electrodes around wound edge 45-90º each treatment session

for acute, localized edema, what waveform should you use? parameters?

use HVPC

frequency: 100-125 pps

pulse duration: 2-100 msec

amplitude: comfortable sensory

active electrode: cathode over edema (repels serum proteins that are - charged)

duration: 20-45 min

for chronic, localized edema, what waveform should you use? parameters?

use russian or biphasic pulsed because you want repetitive muscle action (exercise is better for chronic)

frequency: 20-80 pps (or bps)

pulse duration: 100-600 msec

amplitude: tetanic contraction

on/off time: 1:1 ratio for 1-3 min

duration: 10-20 min

what is iontophoresis? what are the advantages of using this?

a technique that utilizes a direct current to deliver a drug or other substance (in high concentration) through the skin, the substance needs to be ionic in nature because application is polarity dependent

helps minimize adverse local or systemic side-effect

what is the MOA of iontophoresis?

1. repulsion of like charges

2. electroporation - skin naturally hydrophobic, ES temporarily increases skin porosity

3. electroosmosis - volume flow, ions moved into tissue by attraction - na+ and h2o naturally attracted to cathode and cl- attracted to anode

will anodic or cathodic delivery is easier?

anodic

body will assist (+) ions delivered from the anode; (-) ions will need a larger current

literature review: in lateral epicondylitis, iontophoresis with dexamethasone have long term benefits?

no, had short term but no significant difference compared to corticosteroid injections at 6 mo

what color is the anode lead?

red

what must the therapist know before dleivering iontophoretic drug?

1. polarity of ion/drug being used

2. ensure good conductivity

what are the basic components of iontophoretic drug delivery system?

active electrode

inactive electrode

where is the active and inactive electrode placed? what happens if you place electrodes closer together?

active: directly over site to be treated

inactive: over muscle belly at site distant to active electrode

closer placement causes more superficial current penetration up to 1.7cm

what is the dosage equation?

dosage (mA) = current (mA) x duration (min)

what is the typical clinical dosage? what is the common target?

20-80 mA-min depending on patient tolerance

40 mA-min; if lower current, do longer duration, vice versa

can you do iontophoresis at home?

yes, using self-contained patch with battery

how is current density calculated?

CD = mA/cm²

what is the maximum safe current density? (MSCD)

anode: 1.0 mA/cm²

cathode: 0.5 mA/cm²

what is the polarity of dexamethasone?

negative, used as anti-inflammatory

how to apply iontophoresis electrodes?

inspect area and clean with alcohol pad

place active electrode over area to be treated

place inactive electrode over a muscle belly (at least twice the cathode diameter away)

what electrode goes on the treatment site? what is the current amplitude and treatment time?

active electrode depends on the polarity of the drug ion (should be the same charge as the electrode)

current amplitude: to patient comfort (no greater than 4 mA to avoid burns)

treatment time: determined by total treatment dose (20-80 mA-min; 40 mA-min common target)

monitor treatment and check skin after!

what are adverse effects of iontophoresis?

stinging or ant bite sensation

greater risk of skin irritation and redness due to use of DC, not the drug being used

irritation most common under active electrode, important to check skin before and after tx and document any changes

anode is sclerotic/sclerolytic, cathode is sclerotic/sclerolytic

sclerotic, sclerolytic

what are contraindications for iontophoresis?

allergy to drug

pacemaker/implanted device

unstable arrhythmias

malignant tumors

over carotide sinus/ant neck/reproductive organs/chest

venous/arterial thrombophlebitis

areas of active osteomyelitis/active infection

over damaged skin/hemorrhage unless for wound healing

pelvis, abdomen, trunk and LB during pregnancy

precautions for iontophoresis

impaired sensation, mentation, circulation

skin disease/irritation

neuropathies/denervation

active epiphysis

cardiac disease