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Discussion

Electrical Stimulation Therapy

I'm a LVN working in a medical office in Tx and the doctor wants me to initiate the electrical stimulation therapy (i.e. hook pt to machine, turn on and increase the stim level as tolerated by patient) but I am uneasy and not convinced that I am allowed to perform this act. Up to this point I have refused to do without proper training (the doctor recently showed me one time how to hook up a pt) and now the doctor is asking when I'm going to start initiating treatments. I have read TxBON statement re: Delegated Medical

Acts but I'm still not sure if electric stimulation can be a delegated act for an LVN. Please help!!!

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    • Experts

    The LVN scope of practice formulated by the Texas Board of Nursing is wide open. Basically, LVNs in Texas are permitted to perform whatever skills that they are allowed to perform per the policies and procedures of the entities that employ them.

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    E-Stim is not really that difficult. Because you likely haven't taken any therapeutic modalities theory coursework, simply ask the physician what settings to use. Within wounds/injured tissue, there's a lot of K+ floating around in there, so the area is positively charged. You want to entice those K+ ions to go elsewhere, so you need to think about the direction of the flow of current.

    There's also various modes that you'll need to learn about and you'll need to know what the intent is for why the e-stim is being used. TENS units are basically used for pain control. Russian Stim is used for some muscle re-education and strength development. Occasionally Quad-Polar interferential stim can be used.

    I studied Sports Med... so I do know a little about this stuff.

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    • Experts

    When I began the electrical stim therapy in the doctor's office for a torn rotator cuff, they showed me how it worked, then said I could adjust it up as it became comfortable. They had no idea that I was an RN because I'm insured under my husband's policy. Later, when I went to PT, they gave me a portable unit to use at home.

    Makes me wonder though. If they think the average patient can do it when using the office's machine, it bears checking into. You do have to take it slowly at first when you increase the amount of stimulation, so I'm inclined to think patient control under supervision, at first, is best.

    Doesn't really answer your question but it's food for thought,

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    • Author

    Thanks so much for the swift and informative responses.

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    I was a TENS fitter for a podiatry group many years ago in Ohio. It was my job to instruct the patient on use and level of pain to increase as needed post operatively. The company that employed me wanted a licensed professional for the position.

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