Iontophoresis and its uses in medicine.ppt

Medical Ionization electronics

1. MEDICAL IONISATION
•Hanine Hassan
•Lecturer

2. Theory of Medical Ionization
MEDICAL Ionizationistheintroductionoftherapeutic
ionsintothetissuesbytheactionoftheconstant
directcurrent.
Onepadissoakedinasolutioncontainingtheionstobe
introduced,andplacedundertheelectrodebearing,thesame
chargeastheions
Onepadissoakedinaplanewaterandplacedunderthe
indifferentelectrode.
Therequiredionsarerepelledintothetissuesbythelike
chargeontheactiveelectrode.

3. Theory of Medical Ionization
Iontophoresiswhichisalsocalledmedical
ionisation.
Theintroductionofsubstancesintothebodyfor
therapeuticpurposesbymeansofdirectcurrent.
Thesubstanceispreparedinanionicformand
depositedsubcutaneouslyaccordingtothepolarityofthe
ionicsolutionandoftheelectrode.
Itisalongestablishedtechnique,withdocumented
evidenceofitsusegoingbacktothelate1700’sand
early1800’s

4. PROOF of Ionization
•Anexperimenttoprovetheentryofionsintothetissuesundertheinfluence
ofthecurrentwasperformedbyLeducin1903.
•TworabbitswereconnectedinserieswitheachothertoasourceofD.C.
Onepadoneachrabbitwassoakedinasolutionofasaltofstrychnine,the
otherinaharmlesssolution.
•Ononerabbit(A)thecathodewasplacedoverthepadcontainingthe
strychnineions,ontheother(B)theanode.
•Thestrychnineionsbearapositivechargeand,whencurrentwas
passed,therabbitwiththepadcontainingthestrychnineionsunderthe
anode(A)died,whiletheotherrabbit(B)wasunaffected.
•Thustheentryoftheionswasduetotherepellingeffectofthe
anode,nottoabsorptionthroughtheskin.

5. --ve----------------
-+ve-----------
•LEDUC’S EXPERIMENT 1903
PROOF THAT IONS ENTER THE
TISSUES

6. VALUE OF THE METHOD
•Itisnotpossibletoachieveanygreatdepthofpenetrationof
theions.
•Theirspeedofmovementisslow,andthecurrentintensity
anddurationofthetreatmentarelimitedbythepatient's
tolerance.
•Therearemanyionsalreadypresentinthetissues,and
frequentlythesemovemorereadilythanthoseintroduced.
•Also,asSoonastheionsreachthebloodvesselstheyare
carriedawayfromtheareainthebloodstream

7. VALUE OF THE METHOD
•astheionsdonotpenetratebeyondthesuperficialtissues,no
directeffectoftheionscanbeobtainedonthedeepstructures.
•Where,however,effectsarerequiredontheskin,mucous
membranesorsurfacesofwounds,themethodisofvalue.
•Ithastheadvantagesthatthetreatmentcanbeaccurately
localizedandthatdosagecanbeexactlycontrolled.
•Someions,suchastheiodinementionedbelow,maybe
introducedtoenhancetheeffectsoftheconstantD.C.
•Andwhenmedicalionisationisusedtheeffectsofthe
constantD.C.areobtainedinadditiontothoseoftheions
whichareintroduced.

8. VALUE OF THE METHOD
•Aconsiderablevarietyofionshavebeenusedformedical
ionizationinthepast,andnewonesareintroducedfrom
timetotime,
•Butonlyinafewcasesdotheireffectswarrantextensiveuse.
•Afewexamplesaregivenbelowtoillustratetheprinciples
oftreatment,anditshouldbepossibletoapplytheseprinciples
tootherionisationwhichmayberequired.

9. Effects of Various Ions
•Thefollowingionsbearanegativechargeand
soareintroducedunderthecathode.

10. Effects of Various Ions
IODINEIONS:
Theseareobtainedfromasolutionofpotassiumiodideandhavean
irritatingeffectonthesuperficialsensorynerveendings.
Consequentlytheiodineionsincreasethevasodilatationandrelief
ofpainbycounter-irritation
whicharenormallyobtainedatthecathode.
Theyareusedinthetreatmentofchronicinflammatorylesions.
Iodineionisationisalsosometimesusedforsofteningsuperficial
scars,buttheeffectisprobablyduetotheincreasedbloodsupplyandfluid
contentofthetissues,ratherthantoanyspecificeffectoftheiodineions.

11. Effects of Various Ions
CHLORINE IONS:
Theseareobtainedfromasolutionofsodium
chloride
Andhavebeensaidtocausesofteningofscar
tissue,buttheeffectsareprobablydueentirelyto
theactionofthecathode

12. Effects of Various Ions
SALICYLATE IONS:
Theseareobtainedfromasolutionofsodium
Salicylateandaresometimesusedinthetreatment
ofrheumaticconditions.
ItisunlikelythattheSalicylateionsreachthesiteof
thelesion,andthemaineffectisprobablyreliefof
painfromtheanalgesiceffectoftheSalicylateionson
thesuperficialsensorynerveendings.

13. Effects of Various Ions
ALBUCID(Sulphacetamideions):
Theseareobtainedfromasolutionofsodium
Sulphacetamide.
Theydestroycertainbacteriaandaresometimesused
inthetreatmentofinfections
Thefollowingionsbearapositivechargeandsoare
introducedundertheanode.

14. Effects of Various Ions
ZINCIONS:
TheseareobtainedfromasolutionofzincSulphateorzinc
chlorideandareoftenusedinthetreatmentofinfected
superficialwounds,
LIKEsinusesandmucousmembranes,alsofordestroying
exuberantgranulationsonwounds,forsomeinfectionsofthe
ear,hayfeverandcertaineyeconditions.
Whenthezincionspassintothesuperficialtissuestheyreact
withthetissueproteinsformingzincalbuminate,which
appearsasapearlygreyfilmoverthesurfaceandisadherentto
theunderlyingtissues.
Thiseffectismostapparentwhentheionisationisappliedto
thesurfaceofawound,inwhichcasethesuperficialcellsare
destroyedbytheirreactionwiththezincions.

15. Effects of Various Ions
Theionsalsohaveabactericidaleffect.
Thusifawoundistreatedwithzincionisation,theinfected
orindolentsuperficiallayersoftissuearedestroyed,thewound
issterilizedandthelayerofzincalbuminatesealsthesurface,
preventingtheentryofbacteria.
Thetechniquerequiredfortheseconditionsisdescribedinthe
sectionontechniquesforspecialareas.

16. Effects of Various Ions
COPPERIONS:
Theseareobtainedfromasolutionofcoppersulphate,and
havesimilareffectstozincions,
exceptthatinsteadofzincalbuminateabluish-greenfilmof
copperalbuminateisformed.
Theyareusedinthetreatmentofsomeskinconditionsand
fungusinfectionsandmayreplacezincionsinthetreatmentof
wounds.
Thetechniqueissimilartothatrequiredforzincionisation

17. Effects of Various Ions
Histamine:
Histamineisavasodilatorwhichinthepastwaswidelyusedfor
ionisation
Whenhistamineionsareintroducedintothetissues
thetripleresponseisproduced.
Thatis,dilatationofthecapillaries,bythedirecteffectofthe
histamine,
dilatationofthearterioles,bytheaxonreflex,
andexudationoffluidandlocaloedema,asaresultofthe
increasedpermeabilityofthecapillarywalls.

18. IONS OF VASODILATOR DRUGS
•Thelocaleffectsofthevasodilatorsaresimilarto,butmore
markedthan,thoseproducedbyCathodalgalvanism.
•Thelocalhyperemiaandcounter-irritationareofvalue'inthe
treatmentofchronicrheumaticandpost-traumatic
conditionssuchasosteoarthritisrheumatoidarthritis,
fibrositisandtenniselbow,particularlyifthelesionis
localized.
•Thevasodilatationisbeneficialinsomecirculatorydefects,
suchasRaynaud'sdisease,andtheincreaseinbloodsupplyand
exudationoffluidintothetissuesmayhelptosoftensuperficial
scartissue

19. Indications
Inflammation
Analgesia
Musclespasm
Edema
Scartissue
Openskinlesions
Herpes
Gout
Burns
Dystrophy

20. Contraindications
•Skinsensitivityreactions
•Sensitivitytoaspirin(Salicylates)Gastritisor
activestomachulcer(hydrocortisone)
•Asthma(Mecholyl)
•Sensitivitytometals(zinc,copper,magnesium)
•Sensitivitytoseafood(iodine)

21. Iontophoresis
–Effectsoftreatmentdependsontheion(s)delivered
•Musculoskeletalinflammatoryconditions(tendonitis,bursitis)havebeen
successfullytreated:
Usingdexamethosonesodiumphosphate(Decadrone)and
Xylocaine
•Reductionofedemahasbeenachievedbydrivinghyaluronidase
•Transitory(5min)localanesthesiahasbeenproducedbydelivering
lidocainetothetissues.
•Theanesthesiawasbetterthanthatachievedbytopicalapplicationbut
lesseffectivethaninfiltrationoftheareawithlidocaine.

22. Sample MedicationsMeds Pathology Dose Polarity
Acetic Acid Myositis 80mA/min +
Dexamethasone
& Lidocain
Inflammation
& Pain control
41mA/min
& 40 mA
-
Lidocain &
Epinphrine
Pain Control 30mA/min +
Lidocain &
Epinphrine
Pain Control 20 mA/min +
Dexamethasone Inflammation 41mA/min -

23. Technique of Medical Ionisation
•Ionisationswhichrequirespecialtechniqueare
consideredseparately,
•butfortheremainderthetechniqueissimilartothat
foraconstantD.C.treatment.
•Adirectingelectrodemaybeplacedoppositetothat
fromwhichtheionsareintroduced,sothatthey
penetrateasdeeplyaspossible
•anindifferentelectrodemaybeappliedtosome
convenientarea.

24. Technique of Medical Ionisation
•ThepadundertheactiveelectrodeissoakedinaI%or2%
solutionofasaltofthesubstancetobeintroducedandplaced
undertheelectrodebearingthesamechargeastheions.
•Thenumberofionsintroducedintothetissuesdependsonthe
intensityofthecurrentandthedurationofthetreatment,
•i.e.onthequantityofelectricitythatpasses.
•Thereforeashighacurrentdensityastheskincantolerateis
usuallyappliedfor30minutes,thetreatmentbeinggivenon
alternatedays.

25. SOLUTIONS FOR IONISATION
•Thepadiscommonlysoakedina1%or2%solutionofthe
selectedsalt.
•Useofastrongersolutiondoesnotincreasethenumberof
ionsintroduced,becausethisdependsonthecurrentintensity,
whichislimitedbythepatient'stolerance.
•The1or2%solutioncontainsanadequatenumberofions,so
strongersolutionsareawasteofthesaltanymayirritatethe
skin.
•Oneounceofsaltdissolvedin100ouncesofwatermakesa1
percentsolution,andproduces100fluidouncesofthe
solution,
•asthesaltdoesnotincreasethevolumeoftheliquid.

26. Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION
•Thetreatmentmayproducegeneraleffectssothepatient
shouldreceivetheionisationrecliningonacouchandfully
supported.
•Thepulseistakenbeforecommencingtreatment.
•Theindifferentelectrode,attachedtothenegativeterminaland
isappliedtosomeconvenientareaofthebody.
•Theactiveelectrodeshouldnotexceed24squareinches.
•Thehistaminecanbeappliedtotheaffectedareabymeansof
apieceoflintsoakedin1in5,000solutionofhistamineacid
phosphateindistilledwater.

27. Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION
•The1%to2%histaminejellyisspreadevenlyoverthe
markedaffectedareawithaspatula.
•Thencoveredwithasinglepieceoflintandapadofatleast
eightthicknessesoflint.
•Bothsoakedintapwaterandslightlylargerthanthemarked
area.
•Thepatientiswarnedtoreportanydiscomfort,andthroughout
thetreatmenttheoperatormustwatchforanysignsofgeneral
reaction.

28. Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION
•Therearevariousmethodsofassessingthedosagefor
histamineionisation,but¼to½milliamperepersquareinchof
theactivepadforthreeminutesissuitableforthefirst
treatment.
•Butshouldnotexceed120milliampereperminute.
•Attheendofthetreatmentthepadandelectrodeareremoved
andtheskinswabbedwithmethylatedethertoremoveall
tracesofthehistamine.
•Thepatientshouldthenrestforthree-quartersofanhourto
allowthepulserateandbloodpressurereturntonormal.

29. •PRECAUTIONARY MEASUREOFHISTAMINEIONISATION:
•Thesinglepieceoflintusedforthehistamineionizationmust
bedestroyed.
•Theusedpadwashedandreservedforthesecases.
•Histamineisapoisonandsomustbereplacedinthedrug
cupboardimmediatelyafteruse.
•Thetherapistmusttakecareanddoesnotgetthehistaminein
his/herhands.
Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION

30. TECHNIQUE FOR SPECIAL AREAS
•ASUPERFICIALWOUND:
•Azincionisationisdescribed,andasimilartechniqueisusedfortheintroductionof
otherions.
•Alargeindifferentpadandelectrodeareappliedtosomeconvenientarea,which
neednotbeexactlyoppositetotheactiveelectrodeasdeeppenetrationoftheions
isnotessential.
•Ahighcurrentdensityisemployedforthewoundsotheindifferentpadmustbeof
suchasizethatthecurrentrequiredforthewounddoesnotcauseunduesensory
stimulationinthisarea.
•Whenapplyingtheelectrodetothewound,allasepticprecautionsareobserved.
•ThewoundiscleansedwithIpercent.zincsulphatesolutionandanyscabsare
removed.

31. •The skin surrounding the wound is dried and a pad of sterile gauze is
soaked in the zinc sulphatesolution and fitted over the wound.
•Any crevices are filled with ribbon gauze soaked in the zinc sulphate
solution before applying this pad.
•A piece of cellophane, rather larger than the pad, is cleaned with methylated
ether and placed on top of the gauze.
•This prevents the entry of bacteria, and the pad and electrode on top of it
need not be sterile.
•A pad of lint is soaked in tap water and applied over the cellophane, then
the electrode connected to the positive terminal of the source of D.C.
TECHNIQUE FOR SPECIAL AREAS

32. •The pad may extend beyond the edges of the wound,
but as the resistance of the skin is considerably
higher than that of the wound surface, most of the
current passes through the latter.
TECHNIQUE FOR SPECIAL AREAS