Iontophoresis Flashcards
iontophoresis (electrical modality)
> Therapeutic delivery of medication through a non-invasive method of topical delivery of a prescribed medication (ionized drugs) into a localized area of tissue by using the force of direct electrical current to create a therapeutic effect.
methods
• Uses DC current (a small battery charged unit) to move medication across epidermis into the subcutaneous tissue.
o Epidermis is a barrier to water and ionic substances
o DC current of iontophoresor moves the ions of the drug in a particular direction.
o Like charges repel; opposites attract
o Ions ( or medication composed of ions) with a negative charge are moved across the epidermis when connected to a negative electrode charge
o Medication molecules move past the stratum corneum and the drug disperses to all local tissues with the highest concentration in the tissues closest to the electrode site.
o Ion penetration = 1 mm
• Chemical effects from medication extend deeper by capillary action and conduction of current
• Requires doctor’s order for specific type of medication and treatment
• Treatments generally three times a week for 5-9 sessions
techniques
- Iontophoresor: generally takes 10-20 minutes dependent on dosage rate
- Hybresis: an accelerated method of medication delivery that generally take 3 minutes although sensation during delivery may be more intense.
effects
• Reduce inflammation of soft tissue
o Common diagnosis include: epicondylitis, bursitis, tendonitis such as biceps tendonitis or DeQuervain’s tenosynovitis, CTS.
o Medication: 0.4% dexamethasone (- charge): anti-inflammatory
• Reduce calcium deposits
o Common diagnosis: heel spur
o Medication: 2% Acetic Acid (- charge)
• Reduce scar adhesions
o Common Diagnosis: scar adhesions following flexor or extensor tendon repair or Dupytren’s release
o Medication: 2% NaCl (- charge)
effectiveness depends on:
- Use of DC current: increases skin permeability and blood flow
- # of ions transferred
- depth of penetration
- combining of other ions in the skin
- ability of the individual ion to enter the body
- vasodilation from tissue being warmed by exercise or heat modality or vasoconstriction by cold modality will affect the dispersement of medication
Contraindications in addition to general electrical modality precautions
- Allergy to medication
- Allergy to sulfites (preservative to medications)
- Allergies to shellfish – (if using Iodex for scar management)
- Diabetes – alters sugar levels when using corticosteroids
- Precaution: Consider effect of heat on dispersal of medication
Application of traditional iontophoresis:
• Position in a position of relaxation, ask questions, remove creams, lotions that limit penetration.
• Determine polarity of medication and attach lead pads so the medication pad is attached to the same polarity of medication to allow for repel into the epidermis.
o Dexmethasone (negative): anti-inflammatory
• Used for pain & inflammation (OA, bursitis, tendonitis)
o Lidocaine (positive) analgesic anesthetic
• Pain (bursitis, neuritis)
o Acetate (negative) & Iodine (negative)
• Used for sclerotic conditions, scarring, adhesions
o Ketoprofen (negative) anti-inflammatory (NSAIDS)
• Used for chronic inflammation, pain
• Fill medication pad with amount indicated on pad and other dispersive pad with saline provided with pads. Spread evenly.
o Apply pads working (medication) electrode over the treatment site.
o Dispersive (indifferent electrode) over a major muscle approximately 4-6” away.
• Set Treatment Parameters
o Dosage: (current amplitude and time) measured in milliamps-minutes (Mamp x min) This reflects total dosage. Unit defaults to 40 mAmp-min but can increase for a total dose of 80 mAPm-min on future visits as tolerated.
o Current Density: to tolerance (no greater than 3.0 mAmp at first session with max current density of 4.0 mAmp). 2.0 is considered the lowest therapeutic current density and this is where you will begin your first treatment to assess tolerance.
• Prep patient before turn on, encourage to remain still, adjust current density as tolerated once treatment begun
• Apply soothing lotion post treatment, observe skin for galvanic rash to determine if can tolerate higher current density next treatment
documentation
Include site of application, type of medication, current density (mAmp) and current amplitude or final dosage (mAmp-min)
advantages
- Non-invasive alternative to a needle injection such as cortisone with less harmful side effects
- Medication can be delivered to a specific area instead of through the whole body
- Short treatment time
disadvantages
Disadvantages:
• May be uncomfortable for some
• Can leave galvanic rash if current density too high
