Posted on January 5, 2014 by Jim Klett
The successful application of electrotherapy, also called electrical stimulation or “E-stim”, depends a great deal on the effectiveness and longevity of the electrode gel interface between the electrode and patients’ skin. A widely used interface is in the form of a hydrogel that has been proved highly efficient in (1) binding the electrode to the patient’s skin and (2) efficiently dispersing electrical stimulation to the target area(s).
The ability of hydrogel electrodes to reliably perform their functions depends on their ability to retain moisture – that is, remain wet or hydrated. This remaining wet, property also contributes to electrode re-usability. Working against this is electrode gel drying and fouling due to dirt, skin oils, dander and other contaminants that together result in reduced adhesion and conductivity. Drying and fouling result in decreased E-stim therapy effectiveness.
Consequences of Poor Self-Adhering Electrodes
When electrode adhesion deteriorates patients may experience skin irritation, electrical arcing between the electrode and skin (commonly reported as “shocking”), and in the extreme case burns due to arcs of prolonged duration. In this situation severe burns must be reported to appropriate regulatory bodies.
How to Improve Self-Adhesive Electrode Safety
Our technicians developed recommended practices regarding the safe, comfortable and effective use of interferential current therapy. Here’s a short list of symptoms and remedies that can be employed by treating physicians.
- Skin irritation is usually of short duration. Remedies are (1) removing the irritating electrode, (2) using an alternative hydrogel formulation or (3) using a sensitive skin hydrogel formulation. In the latter case the downside is reduced adhesive properties.
- Shocking or arcing, aka “edge biting,” occurs when hydrogel dries or is fouled. If this causes a gap between the electrode and the skin electrical current will seek a ground. The circuit is completed when it jumps to the skin. Think in terms of a spark caused by static electricity. While arcing is not a safety issue the discomfort can result in patient non-compliance with electrotherapy. The remedy is replacing the electrode.
- Prolonged arcing results in burns that are classified as 1st or 2nd degree. At TheraSigma we have no knowledge of burns causing permanent damage to body tissues or requiring medical intervention to prevent permanent damage. The predominant causes of burns are overuse of electrodes, sharing electrodes, and attempting to extend electrode life by wetting with water. All should be avoided.
Electrotherapy Best Practices Check List for Practitioners and Patients
Physicians and physical therapists can promote self-adhesive electrode comfort and safety by
- maintaining a stock of hydrogel electrodes
- encouraging patients to keep fresh electrodes on hand for use as needed or on a regular basis
- explaining at the outset that regular replacement is important to effective treatment as well as comfort and safety
- sharing relevant points below on getting the maximum service from their self-adhering electrodes
How to Extend Electrotherapy Electrode Life
Yes, electrode life can be extended but not indefinitely. How many times they can be used depends on:
- Electrode quality
- Handling and storage by patients
- Skin condition
- Skin cleanliness
- Extent of use, i.e. periodic or continuous
- Internal and external environmental conditions
We list electrode quality first because the other points are not controlled by manufacturers. Premium quality electrodes exemplified by our range of pain management products deliver longer service life provided they are not “abused” by patients. Interestingly, premium quality hydrogel electrodes do not always command a price premium. This is largely due to up-pricing of inferior quality products. For that reason physicians should recommend fresh premium-grade electrodes for muscle stimulation and electrotherapy.
An important benefit of a premium grade product is improved patient compliance due to the reduction or elimination discomfort caused by poor electrode adhesion.
Contact the electrotherapy experts at TheraSigma for more information on our line of pain management products. We invite you to download our white paper What you should Know about Hydrogel Electrodes for an in-depth look at this important topic.