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Clinical Skills 2 > E-stim for tissue healing and iontophoresis > Flashcards

E-stim for tissue healing and iontophoresis Flashcards

1
Q

Wound healing stages

A
  • hemostasis and coagulation
  • inflammation: lysis = removal or cellular debris
  • proliferation and migration: neutrophils and lymphocytes come to the area
  • remodeling
    **typically with chronic wounds they get stuck in the inflammatory/proliferative phase
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2
Q

Purpose/effects of E-stim for tissue healing

A
  • stimulate cells
  • increase blood flow
  • combat infeciton
  • reduce edema
  • increase protein synthesis and cell migration
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3
Q

Mechanism for wound healing

A
  • ionic effects (galvanotaxis)
  • germicidal effect
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4
Q

Ionic effects of wound healing (galvanotaxis)

A
  • the attraction of cells to an electrical charge
  • used to induce cell migration
  • E-stim for tissue healing is depend on net charge
  • negative electrode attracts positively charged ions and repels negatively charged ions and vice versa for positive electrode
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5
Q

Germicidal effects of wound healing

A
  • monophasic currents have been shown to inhibit bacteria growth and kill bacteria
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6
Q

Waveforms that create ionic effects

A
  • DC current
  • Pulsed monophasic current
  • unbalanced biphasic current
  • Monophasic pulsed current: HVGS = high volt galvanic stimulation; HVPC = high volt pulsed current (most common)
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7
Q

Ionic effects based on the theory of attraction

A
  • neutrophils, macrophages, lymphocytes, platelets, mast cells, keratinocytes and fibroblasts can be attracted to a wound based on the charge they carry
  • Negative charge is used for treatment of infection/inflamed wounds
  • positive charge is used for treatment for epithelialization or if the wound healing plateaues
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8
Q

Pre- set up considerations

A
  • check sensation (may be impaired so can check intensity on a near by area)
  • use infection control methods for infected wounds
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9
Q

Infection control methods for infected wounds

A
  • single use electrode
  • use standard precautions used when blood or body fluids may be present
  • dispose of gauze properly
  • personal protective equipment
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10
Q

Electrode placement for tissue healing

A
  • one electrode is treatment electrode; has polarity and placed in or around wound
  • Dispersive electrode: at least 2x the surface area of active electrode
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11
Q

Monopolar set up for tissue healing

A
  • smaller electrode is treatment electrode
  • larger dispersive electrode of opposite polarity is placed on intact skin, close to the wound site
  • dispersive: larger size allows current to be dispersed over a larger area for more comfort and not limiting intensity of other electrode
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12
Q

Direct vs indirect method for tissue healing

A
  • direct = treatment electrode is directly over wound
  • indirect = bifurcating electrodes around the wound
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13
Q

Parameters for tissue healing e-stim

A
  • waveform: monophasic pulsed current or HVPS (HVGS)
  • polarity: (-) inflammatory phase/infection or (+) for epithelialization/proliferation phase or clean
  • pulsed duration: can be preset but usually 40-100 microseconds
  • pulse freq. 60-125
  • amplitude: to comfortable tingling sensation without a motor response
  • treatment: 40-60 minutes
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14
Q

Iontophoresis

A
  • based on theory of repulsion
  • the use of low amplitude DC current to facilitate trans-dermal drug delivery
  • based on the theory that like charges repel and fixed charge can push the drug away from electrode
  • uses a monopolar set up – one treatment and one larger dispersive electrode
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15
Q

Effects of DC current (iontophoresis)

A
  • to promote contious delivery of a drug continuous DC current is necessary
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16
Q

Alkaline reaction

A
  • can occur under negative electrode due to formation of sodium hydroxide
  • can cause discomfort, skin irritation or chemical burns
  • larger electrodes or reduced current amplitude can decrease the risk of adverse response
17
Q

Acidic reaction

A
  • can occur under the positive electrode due to the formation of hydrochloric acid
  • this can create skin discomfort but is generally less uncomfortable than an alkaline reaction
  • alkaline burns tend to be more damaging and painful
18
Q

Iontophoresis dosage

A
  • determined by the specific design of unit
  • usually described in milliamp minutes
  • 1 milliamp of intensity = 40 mintues to get to proper dose
19
Q

Parameters for iontophoresis

A
  • polarity: drug delivery electrode = same as drug
  • current amplitude = usually 0.1-4.0 mA, determined by patient comfort and the allowable amplitude within the unit
  • treatment time: determined by amplitude necessary to achieve dosage goal (usually 40-80 mAmin)
20
Q
  1. Dexamethasone 0.4%
  2. lidocaine 5%
  3. acetate 2.5-5%
  4. tap water
A
  1. (-) used for inflammation
  2. (+) used for local anesthetic
  3. (-) calcium deposits
  4. (+,-) hyperhidrosis (excessive sweating)

Clinical Skills 2 (13 decks)

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