PURPOSE To describe the safe use of ultrasound therapy POLICY STATEMENTS All electrophysical agents must be used in accordance with College of Physical Therapists of BC practice standards. Ultrasound therapy (US) is an electrotherapeutic modality used by physiotherapists to induce physiological changes which increase the rate of tissue repair after injury. US is preferentially absorbed by tissues with a high protein content. INDICATIONS 1. pain relief 2. decrease tissue swelling 3. increase tissue metabolism 4. increase soft tissue extensibility 5. assist muscle relaxation 6. increase blood flow 7. soften connective tissue 8. promote wound healing 9. alter nerve conduction velocity 10. altered scar tissue formation ( improved scar using low dose US as it increases secretion of collagen from fibroblasts) CONTRAINDICATIONS The application of therapeutic levels of ultrasound will be contraindicated over the following areas: 1. eyes 2. heart in cardiac disease and with pacemaker implants 3. any implanted devices (i.e. pacemaker)( no Medtronic devices) 4. reproductive organs 5. abdomen during pregnancy 6. brain tissue 7. neoplastic tissue 8. areas of haemorrhage 9. epiphysial plates (continuous ultrasound) 10. anterior neck or carotid sinus And under the following conditions 1. lack of sensation 2. acute sepsis/tuberculosis 3. thrombophlebitis, deep vein thrombosis Policy # PT.03.02 BCCH Child & Youth Health Policy and Procedure Manual Page 1 of 5
4. radiotherapy treatment within the last 6 months 5. haemophilia patients without factor replacement 6. development of additional pain during treatment 7. myositis ossificans 8. abscess 9. cognitive impairment 10. impaired circulation PRECAUTIONS Pulsed or continuous ultrasound may be applied with caution to following sites, lower intensity and more frequent monitoring are required: 1. spinal cord or superficial peripheral nerves 2. regenerating nerves 3. active epiphysis 4. fragile skin Pulsed ultrasound may be applied with caution to following sites, lower intensity and more frequent monitoring are required: 1. cement or plastic implants under intact skin 2. areas of impaired sensation 3. cognitive or communication impairments 4. areas of impaired circulation, provided pain is not exacerbated 5. areas affected by heat sensitive skin diseases (eczema) 6. infected tissues with open drainage 7. areas with regenerating nerves 8. tissues inflamed from exacerbation of chronic inflammatory conditions SITE APPLICABILITY Inpatients/Outpatients PRACTICE LEVEL/COMPETENCIES Advanced Skill - Provides physiotherapy assessments using advanced skill, knowledge and clinical reasoning within assigned area. Applies advanced clinical knowledge and reasoning to the development and implementation of physiotherapy treatment programs in accordance with established standards of the College of Physical Therapists of BC. EQUIPMENT Ultrasound PROCEDURE 1. Assess patient history and investigate contraindications Rationale Policy # PT.03.02 BCCH Child & Youth Health Policy and Procedure Manual Page 2 of 5
2. Obtain consent for treatment 3. Ensure safe practice before beginning a) Perform a sensory discrimination test ask patient to differentiate between hot and cold stimuli or between light tough and painful stimuli b) Inspect skin area avoid open skin c) Avoid transfer of infectious agents clean head after with an alcohol wipe, ensure gel bottle does not become contaminated d) Avoid pre-treatment of area with superficial heating or cooling e) Ensure proper supervision at all times f) Clean skin to remove lotions, use proper gel skin is clean with soap or alcohol g) Limit thermal ultrasound treatment surface areas less than 10 cm 2 h) Ensure effective treatment duration pulsed ultrasound should not be less than 10 minutes i) Ensure regular maintenance and calibrations of machines 4. Parameters are determined based on patient s condition/location of injury It is not sufficient to test light touch only as light touch and pain/temperature are transmitted on different neural pathways. The sensory test should always be performed when using continuous mode ultrasound Avoid areas affected by psoriasis, eczema or other skin disorders Treatment time should be 5-10 mins per treatment area. Treatment area is defined as 2X the area of the transducer face. Treatment frequency: acuteonce perday low dose; chronic-alternate days using higher dose. Policy # PT.03.02 BCCH Child & Youth Health Policy and Procedure Manual Page 3 of 5
5. Ultra sound gel is applied to area to be treated 6. Appropriate equipment head size is selected and applied 7. Duration of treatment is set 8. Treatment head is kept in a slow, continuous motion. Treatment head must be kept at 90 and if full contact with tissue being treated. 9. The patient is regularly asked to report any sensations felt and the treatment is modified accordingly 10. When the treatment is terminated: a) equipment is switched off b) patient s skin and treatment head are cleaned c) the expected results are assessed d) the patent is asked to comment after treatment on any reactions that may occur DOCUMENTATION To decrease chance of tissue damage from localized regions of high intensity US hot spot To decrease the risk of damage to the transducer head and to ensure sound waves are absorbed by the tissue and not reflected along periostium of bone causing pain Policy # PT.03.02 BCCH Child & Youth Health Policy and Procedure Manual Page 4 of 5
Record treatment given including power, intensity, frequency, pulsing regime and duration in chart Record the area treated, and mode chosen continuous or pulsed As per College of Physical Therapists of BC practice standards REFERENCES Electrophysical Agents: Contraindications and Precautions: An evidence based approach to clinical decision making in physical therapy, 2010. Physiotherapy Canada, 62 (5), special issue, 13-25. Watson, T. (2002). "Ultrasound Dose Calculations" In Touch 101;14-17 College of Physical Therapists of BC Practice Standard Number 2: Electrophysical Agents. Retrieved September 6, 2013, from http://www.cptbc.org/pdf/practicestandards/practicestandards2.pdf Policy # PT.03.02 BCCH Child & Youth Health Policy and Procedure Manual Page 5 of 5