With percutaneous tibial nerve stimulation (PTNS) with Urgent® PC, good technique plays a huge part in optimal patient outcomes. The key is to have the needle closest to the tibial nerve without hitting it and the stimulation as strong as it is tolerable.
While the standard procedure is a baseline, most practitioners refine their technique as they learn what works best for their patients. The following are some technique tips from clinical practitioners to get you started.
Needle Depth and Angle
A recent blog from Diane Newman, RNC, MSN, CRNP, FAAN, addresses the question of needle electrode insertion depth and angle head on. In summary, it varies and is largely influenced by patient factors such as the size of the ankle. In a blog on Urgent PC technique, Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD, corroborates this opinion and stresses that you should never insert the needle at less than 60° as it’s unlikely that the needle we be close enough to the tibial nerve to get a good response. Read more about inserting the needle.
Motor vs. Sensory Response
What patient response do you need to demonstrate that the needle is inserted correctly and is working? Wooldridge provides this top tip. “If the patient is feeling the “buzzing” around the needle site, most likely you are not in far enough. Continue to advance the needle until the proper response is noted. Yes, you can get needle buzzing along with toe(s) flexion and foot/heel response for a positive response. You can also get either toe movement OR heel/foot response. Or patients can just have a sensory response. Any is acceptable.” Read more about obtaining motor or sensory response during treatment.
Dealing with Difficult Ankles
A one-size-fits-all approach doesn’t always work for PTNS, especially since ankles come in all sizes. In this blog, Wooldridge provides helpful pointers for different types of ankles. For example, a thinner leg means there’s less distance between the outer leg and the tibia nerve. As a result, slow and steady is the way to go. With edematous ankles, Wooldridge starts by trying to minimize edema by having patients use compression socks and scheduling appointments first thing in the morning. She also have tips for visible veins and tough, leathery skin.
As you likely know, the treatment levels correspond to the amount of current (0 – 9 mA) being delivered during treatment. Of course, the needed current varies by treatment session based on factors such as needle depth and location. That’s why treatment setting typically varies from session to session. Most patients don’t feel anything before level 3 or 4. At that point, it’s important to pause between level increases to observe for a motor response and to ask the patient if they feel anything. Wooldridge increases stimulation to the highest level that is tolerable for the patients. Remember you can arrow down if the sensation is too strong. Read more about stimulation levels for PTNS
The best technique typically yields the best results. If you don’t think you’re getting the results you should or if you have questions about PTNS technique, contact customer care or your territory manager.
Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Urgent is a registered trademark. © 2016 Cogentix Medical. All rights reserved.