Re: Russian estim and pacemakers

[Guest guest]

I have not seen any research on this either. I always call the manufacturers

number on the back of the patients pacemaker card and ask them. You sometimes

get varying info, but I understood from one of them that the newer demand type

of pacemaker is not as big a deal as long as you don't place electrodes(or

cross

current) right over chest.

Greg Noel

________________________________

To: PTManager

Sent: Wed, April 27, 2011 8:00:45 AM

Subject: Russian estim and pacemakers

 

Hi group!

I wanted to pose a question to the group about the use of Russian stim/NMES over

the knee in people who have pacemakers. Depending on where you look estim is

either a " relative contraindication " or an " absolute contraindication. " As

someone who is in the research consistently, I can't seem to find any definitive

evidence saying that it's unsafe. Sure, it may be best policy to avoid the risk,

but in someone that can really use it, does anyone have any reason as to why we

can't? Has anyone used it and been OK? Or, is this something that we just need

to get approval from the docs on...

Thanks

Dan Lorenz

Olathe, KS

[Guest guest]

I have not seen any research on this either. I always call the manufacturers

number on the back of the patients pacemaker card and ask them. You sometimes

get varying info, but I understood from one of them that the newer demand type

of pacemaker is not as big a deal as long as you don't place electrodes(or

cross

current) right over chest.

Greg Noel

________________________________

To: PTManager

Sent: Wed, April 27, 2011 8:00:45 AM

Subject: Russian estim and pacemakers

 

Hi group!

I wanted to pose a question to the group about the use of Russian stim/NMES over

the knee in people who have pacemakers. Depending on where you look estim is

either a " relative contraindication " or an " absolute contraindication. " As

someone who is in the research consistently, I can't seem to find any definitive

evidence saying that it's unsafe. Sure, it may be best policy to avoid the risk,

but in someone that can really use it, does anyone have any reason as to why we

can't? Has anyone used it and been OK? Or, is this something that we just need

to get approval from the docs on...

Thanks

Dan Lorenz

Olathe, KS

[Guest guest]

Dan:

I had a similar situation except Pan Management Physician wanted to use home TNS

Unit for chronic low back pain (96 year old) and I was very uncomfortable

despite MD and patient requesting application. How I resolved the situation was

to contact the Pacemaker manufacturer (I had identification numbers for unit and

lead wires) and received assurances from manufacturer and guidelines for safe

application of TNS Unit for that patient. All of this information was given to

patient/family and maintained in patient's chart. After 6 months patient is

still using TNS Unit for pain modulation (rather than medications that were

sedating her causing falls) and no ill effects on cardiac function. I would

strongly suggest investigating each patient/situation rather than making

generalizations because the manufacturer can direct you to specific precautions

and recommendations for that particular patient/pace maker.

I hope this information helps!

Stuart J. Meaux, P. T., MSHA

Director of Physical Rehabilitation Services

Sacred Heart Hospital on the Emerald Coast

Miramar Beach, Florida

(w)

©

(p)

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

dannyboylorenz

Sent: Wednesday, April 27, 2011 8:01 AM

To: PTManager

Subject: Russian estim and pacemakers

Hi group!

I wanted to pose a question to the group about the use of Russian stim/NMES over

the knee in people who have pacemakers. Depending on where you look estim is

either a " relative contraindication " or an " absolute contraindication. " As

someone who is in the research consistently, I can't seem to find any definitive

evidence saying that it's unsafe. Sure, it may be best policy to avoid the risk,

but in someone that can really use it, does anyone have any reason as to why we

can't? Has anyone used it and been OK? Or, is this something that we just need

to get approval from the docs on...

Thanks

Dan Lorenz

Olathe, KS

[Guest guest]

Dan:

I had a similar situation except Pan Management Physician wanted to use home TNS

Unit for chronic low back pain (96 year old) and I was very uncomfortable

despite MD and patient requesting application. How I resolved the situation was

to contact the Pacemaker manufacturer (I had identification numbers for unit and

lead wires) and received assurances from manufacturer and guidelines for safe

application of TNS Unit for that patient. All of this information was given to

patient/family and maintained in patient's chart. After 6 months patient is

still using TNS Unit for pain modulation (rather than medications that were

sedating her causing falls) and no ill effects on cardiac function. I would

strongly suggest investigating each patient/situation rather than making

generalizations because the manufacturer can direct you to specific precautions

and recommendations for that particular patient/pace maker.

I hope this information helps!

Stuart J. Meaux, P. T., MSHA

Director of Physical Rehabilitation Services

Sacred Heart Hospital on the Emerald Coast

Miramar Beach, Florida

(w)

©

(p)

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

dannyboylorenz

Sent: Wednesday, April 27, 2011 8:01 AM

To: PTManager

Subject: Russian estim and pacemakers

Hi group!

I wanted to pose a question to the group about the use of Russian stim/NMES over

the knee in people who have pacemakers. Depending on where you look estim is

either a " relative contraindication " or an " absolute contraindication. " As

someone who is in the research consistently, I can't seem to find any definitive

evidence saying that it's unsafe. Sure, it may be best policy to avoid the risk,

but in someone that can really use it, does anyone have any reason as to why we

can't? Has anyone used it and been OK? Or, is this something that we just need

to get approval from the docs on...

Thanks

Dan Lorenz

Olathe, KS

[Guest guest]

Don't see an issue as long as your fields are separate from the actual

pacemaker and unusual safety protocols are followed

Neuromuscular electric stimulation in heart transplantation candidates

with cardiac pacemakers.

Wiesinger GF, Crevenna R, Nuhr MJ, Huelsmann M, Fialka-Moser V, Quittan

M.

This study looked at stim use on the knee and deemed it safe

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

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Russian estim and pacemakers

Hi group!

I wanted to pose a question to the group about the use of Russian

stim/NMES over the knee in people who have pacemakers. Depending on

where you look estim is either a " relative contraindication " or an

" absolute contraindication. " As someone who is in the research

consistently, I can't seem to find any definitive evidence saying that

it's unsafe. Sure, it may be best policy to avoid the risk, but in

someone that can really use it, does anyone have any reason as to why we

can't? Has anyone used it and been OK? Or, is this something that we

just need to get approval from the docs on...

Thanks

Dan Lorenz

Olathe, KS

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[Guest guest]

Hi, Dan. It depends on who you ask. A few years ago we (at my former

employer) asked St. Jude, and they responded with a fact sheet that said it

was safe to use TENS on patients using their pacemakers, even demand type,

at intensities not to exceed 4mA, not directly over the pacemaker or leads,

and electrodes closely spaced. With documentation of informed consent and

the blessing of the cardiologist responsible for implanting it, we

successfully used TENS on a handful of patients with pacemakers without

incident. Before everybody rushes out to hook all their cardiac rehab

patients up to their Chattanoogas, I want to share a conversation I had with

the Medtronic specialist who attended my husband's implant surgery. I

asked why their instruction manual has warnings to avoid TENS with their

implantable devices. He said the official response is that any of them can

inadvertently be reprogrammed by electromagnetic fields, and this could

cause a defib to go off unexpectedly, too much medication to be delivered,

etc; or that impulses from the TENS could travel on the Medtronic leads and

cause tissue damage. He went on to share that although the likelihood of

these adverse reactions is remote, the warnings were prompted by a lawsuit

that Medtronic lost (or settled.) A person with an implant into the CNS

(maybe spinal cord or deep brain stimulator or intrathecal pump) suffered

devastating injury when therapeutic US was inappropriately administered and

components of the implant heated and burned the nerves. (Nothing to do with

TENS, but they evidently let their malpractice underwriter overhaul their

manuals.)

I usually handle this on an individual basis. If I have a patient with a

pacemaker, I keep a copy of the pacemaker card from the patient in the

medical record. If I want to try TENS, I contact the manufacturer to

determine risks/contraindications for that particular unit (serial # on the

card.) They will tell me if it's safe, if the pacemaker needs to be

reprogrammed, etc. I share the info with the responsible physician (also on

the card) to receive clearance then obtain informed consent from the

patient.

Diane , PT

Augusta, GA

On Wed, Apr 27, 2011 at 9:00 AM, dannyboylorenz wrote:

>

>

> Hi group!

>

> I wanted to pose a question to the group about the use of Russian stim/NMES

> over the knee in people who have pacemakers. Depending on where you look

> estim is either a " relative contraindication " or an " absolute

> contraindication. " As someone who is in the research consistently, I can't

> seem to find any definitive evidence saying that it's unsafe. Sure, it may

> be best policy to avoid the risk, but in someone that can really use it,

> does anyone have any reason as to why we can't? Has anyone used it and been

> OK? Or, is this something that we just need to get approval from the docs

> on...

>

> Thanks

> Dan Lorenz

> Olathe, KS

>

>

>