MEDICAL IONISATION

• Dr. Naveed Ahmad, PT

• Lecturer
• STMU Islamabad
Theory of Medical Ionization

 MEDICAL Ionization is the introduction of therapeutic

ions into the tissues by the action of the constant direct
current.

 One pad is soaked in a solution containing the ions to be

introduced, and placed under the electrode bearing, the same
charge as the ions

 One pad is soaked in a plane water and placed under the

indifferent electrode.

 The required ions are repelled into the tissues by the like charge
on the active electrode.
Theory of Medical Ionization
 Iontophoresis which is also called medical
ionisation.

 The introduction of substances into the body for

therapeutic purposes by means of direct current.

 The substance is prepared in an ionic form and

deposited subcutaneously according to the polarity of the
ionic solution and of the electrode.

 It is a long established technique, with documented

evidence of its use going back to the late 1700’s and
early 1800’s
PROOF of Ionization
• An experiment to prove the entry of ions into the tissues under the influence
of the current was performed by Leduc in 1903.

• Two rabbits were connected in series with each other to a source of D.C.
One pad on each rabbit was soaked in a solution of a salt of strychnine, the
other in a harmless solution.

• On one rabbit (A) the cathode was placed over the pad containing the
strychnine ions, on the other (B) the anode.

• The strychnine ions bear a positive charge and, when current was
passed, the rabbit with the pad containing the strychnine ions under the
anode (A) died, while the other rabbit (B) was unaffected.

• Thus the entry of the ions was due to the repelling effect of the
anode, not to absorption through the skin.
PROOF THAT IONS ENTER THE
TISSUES

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• LEDUC’S EXPERIMENT 1903

VALUE OF THE METHOD
• It is not possible to achieve any great depth of penetration of
the ions.

• Their speed of movement is slow, and the current intensity

and duration of the treatment are limited by the patient's
tolerance.

• There are many ions already present in the tissues, and

frequently these move more readily than those introduced.

• Also, as Soon as the ions reach the blood vessels they are
carried away from the area in the blood stream
VALUE OF THE METHOD
• as the ions do not penetrate beyond the superficial tissues, no
direct effect of the ions can be obtained on the deep structures.

• Where, however, effects are required on the skin, mucous

membranes or surfaces of wounds, the method is of value.

• It has the advantages that the treatment can be accurately

localized and that dosage can be exactly controlled.

• Some ions, such as the iodine mentioned below, may be

introduced to enhance the effects of the constant D.C.

• And when medical ionisation is used the effects of the

constant D.C. are obtained in addition to those of the ions
which are introduced.
VALUE OF THE METHOD

• A considerable variety of ions have been used for medical

ionization in the past, and new ones are introduced from
time to time,

• But only in a few cases do their effects warrant extensive use.

• A few examples are given below to illustrate the principles

of treatment, and it should be possible to apply these principles
to other ionisation which may be required.
Effects of Various Ions

• The following ions bear a negative charge and

so are introduced under the cathode.
 Effects of Various Ions

 IODINE IONS:

 These are obtained from a solution of potassium iodide and have an

irritating effect on the superficial sensory nerve endings.

 Consequently the iodine ions increase the vasodilatation and relief

of pain by counter-irritation
 which are normally obtained at the cathode.

 They are used in the treatment of chronic inflammatory lesions.

 Iodine ionisation is also sometimes used for softening superficial

scars, but the effect is probably due to the increased blood supply and fluid
content of the tissues, rather than to any specific effect of the iodine ions.
Effects of Various Ions

CHLORINE IONS:

 These are obtained from a solution of sodium

chloride

 And have been said to cause softening of scar

tissue, but the effects are probably due entirely to
the action of the cathode
Effects of Various Ions

 SALICYLATE IONS:

 These are obtained from a solution of sodium

Salicylate and are sometimes used in the treatment
of rheumatic conditions.

 It is unlikely that the Salicylate ions reach the site of

the lesion, and the main effect is probably relief of
pain from the analgesic effect of the Salicylate ions on
the superficial sensory nerve endings.
Effects of Various Ions

 ALBUCID (Sulphacetamide ions):

 These are obtained from a solution of sodium

Sulphacetamide.

 They destroy certain bacteria and are sometimes used

in the treatment of infections

 The following ions bear a positive charge and so are

introduced under the anode.
Effects of Various Ions
 ZINC IONS:
 These are obtained from a solution of zinc Sulphate or zinc
chloride and are often used in the treatment of infected
superficial wounds,

 LIKE sinuses and mucous membranes, also for destroying

exuberant granulations on wounds, for some infections of the
ear, hay fever and certain eye conditions.

 When the zinc ions pass into the superficial tissues they react
with the tissue proteins forming zinc albuminate, which
appears as a pearly grey film over the surface and is adherent to
the underlying tissues.

 This effect is most apparent when the ionisation is applied to

the surface of a wound, in which case the superficial cells are
destroyed by their reaction with the zinc ions.
Effects of Various Ions
 The ions also have a bactericidal effect.

 Thus if a wound is treated with zinc ionisation, the infected

or indolent superficial layers of tissue are destroyed, the wound
is sterilized and the layer of zinc albuminate seals the surface,
preventing the entry of bacteria.

 The technique required for these conditions is described in the

section on techniques for special areas.
Effects of Various Ions
 COPPER IONS:

 These are obtained from a solution of copper sulphate, and

have similar effects to zinc ions,

 except that instead of zinc albuminate a bluish-green film of

copper albuminate is formed.

 They are used in the treatment of some skin conditions and

fungus infections and may replace zinc ions in the treatment of
wounds.

 The technique is similar to that required for zinc ionisation

Effects of Various Ions
 Histamine:

 Histamine is a vasodilator which in the past was widely used for

ionisation

 When histamine ions are introduced into the tissues

the triple response is produced.

 That is, dilatation of the capillaries, by the direct effect of the

histamine,
 dilatation of the arterioles, by the axon reflex,
 and exudation of fluid and local oedema, as a result of the
increased permeability of the capillary walls.
IONS OF VASODILATOR DRUGS

• The local effects of the vasodilators are similar to, but more
marked than, those produced by Cathodal galvanism.

• The local hyperemia and counter-irritation are of value' in the

treatment of chronic rheumatic and post-traumatic
conditions such as osteoarthritis rheumatoid arthritis,
fibrositis and tennis elbow, particularly if the lesion is
localized.

• The vasodilatation is beneficial in some circulatory defects,

such as Raynaud's disease, and the increase in blood supply and
exudation of fluid into the tissues may help to soften superficial
scar tissue
Indications
 Inflammation
 Analgesia
 Muscle spasm
 Edema
 Scar tissue
 Open skin lesions
 Herpes
 Gout
 Burns
 Dystrophy
Contraindications
• Skin sensitivity reactions

• Sensitivity to aspirin (Salicylates) Gastritis or

active stomach ulcer (hydrocortisone)

• Asthma (Mecholyl)

• Sensitivity to metals (zinc, copper, magnesium)

• Sensitivity to seafood (iodine)

Iontophoresis
– Effects of treatment depends on the ion(s) delivered

• Musculoskeletal inflammatory conditions (tendonitis, bursitis) have been

successfully treated:
Using dexamethosone sodium phosphate (Decadrone) and
Xylocaine

• Reduction of edema has been achieved by driving hyaluronidase

• Transitory (5min) local anesthesia has been produced by delivering

lidocaine to the tissues.

• The anesthesia was better than that achieved by topical application but
less effective than infiltration of the area with lidocaine.
Sample Medications
Meds Pathology Dose Polarity

Acetic Acid Myositis 80mA/min +

Dexamethasone Inflammation 41mA/min -

& Lidocain & Pain control & 40 mA
Lidocain & Pain Control 30mA/min +
Epinphrine
Lidocain & Pain Control 20 mA/min +
Epinphrine
Dexamethasone Inflammation 41mA/min -
Technique of Medical Ionisation
• Ionisations which require special technique are
considered separately,

• but for the remainder the technique is similar to that

for a constant D.C. treatment.

• A directing electrode may be placed opposite to that

from which the ions are introduced, so that they
penetrate as deeply as possible
• an indifferent electrode may be applied to some
convenient area.
Technique of Medical Ionisation
• The pad under the active electrode is soaked in a I % or 2 %
solution of a salt of the substance to be introduced and placed
under the electrode bearing the same charge as the ions.

• The number of ions introduced into the tissues depends on the

intensity of the current and the duration of the treatment,

• i.e. on the quantity of electricity that passes.

• Therefore as high a current density as the skin can tolerate is

usually applied for 30 minutes, the treatment being given on
alternate days.
SOLUTIONS FOR IONISATION
• The pad is commonly soaked in a 1 % or 2 % solution of the
selected salt.
• Use of a stronger solution does not increase the number of
ions introduced, because this depends on the current intensity,
which is limited by the patient's tolerance.
• The 1 or 2 % solution contains an adequate number of ions, so
stronger solutions are a waste of the salt any may irritate the
skin.

• One ounce of salt dissolved in 100 ounces of water makes a 1

per cent solution, and produces 100 fluid ounces of the
solution,

• as the salt does not increase the volume of the liquid.

Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION
• The treatment may produce general effects so the patient
should receive the ionisation reclining on a couch and fully
supported.

• The pulse is taken before commencing treatment.

• The indifferent electrode, attached to the negative terminal and

is applied to some convenient area of the body.

• The active electrode should not exceed 24 square inches.

• The histamine can be applied to the affected area by means of

a piece of lint soaked in 1 in 5,000 solution of histamine acid
phosphate in distilled water.
Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION

• The 1 % to 2 % histamine jelly is spread evenly over the

marked affected area with a spatula.

• Then covered with a single piece of lint and a pad of at least

eight thicknesses of lint.

• Both soaked in tap water and slightly larger than the marked
area.

• The patient is warned to report any discomfort, and throughout

the treatment the operator must watch for any signs of general
reaction.
Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION
• There are various methods of assessing the dosage for
histamine ionisation, but ¼ to ½ milli ampere per square inch of
the active pad for three minutes is suitable for the first
treatment.

• But should not exceed 120 milliampere per minute.

• At the end of the treatment the pad and electrode are removed
and the skin swabbed with methylated ether to remove all
traces of the histamine.

• The patient should then rest for three-quarters of an hour to

allow the pulse rate and blood pressure return to normal.
 Technique of Ionisation with Vasodilator Drugs
HISTAMINE IONISATION
• PRECAUTIONARY MEASURE OF HISTAMINE IONISATION:

• The single piece of lint used for the histamine ionization must
be destroyed.

• The used pad washed and reserved for these cases.

• Histamine is a poison and so must be replaced in the drug

cupboard immediately after use.

• The therapist must take care and does not get the histamine in
his/her hands.
TECHNIQUE FOR SPECIAL AREAS
• A SUPERFICIAL WOUND:
• A zinc ionisation is described, and a similar technique is used for the introduction of
other ions.

• A large indifferent pad and electrode are applied to some convenient area, which
need not be exactly opposite to the active electrode as deep penetration of the ions
is not essential.

• A high current density is employed for the wound so the indifferent pad must be of
such a size that the current required for the wound does not cause undue sensory
stimulation in this area.

• When applying the electrode to the wound, all aseptic precautions are observed.

• The wound is cleansed with I per cent. zinc sulphate solution and any scabs are
removed.
TECHNIQUE FOR SPECIAL AREAS
• The skin surrounding the wound is dried and a pad of sterile gauze is
soaked in the zinc sulphate solution 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

• 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.
 End OF Lecture 06

Best Of Luck to All

For MID EXAM

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