Ann Thorac Surg 1999;67:1184-1185
© 1999 The Society of Thoracic Surgeons
How to Do It
Iodine-impregnated drapes enable recording of precordial electrocardiogram
Yoshihiko Mochizuki, MDa,
Yoshitaka Okamura, MDa,
Hiroshi Iida, MDa,
Hideaki Mori, MDa,
Koichiro Shimada, MDa
a Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Tochigi, Japan
Accepted for publication September 30, 1998.
Address reprint request to Dr Mochizuki, Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi Mibucho Shimotsugagun, Tochigi, 321-0293, Japan
e-mail: mochi{at}dokkyomed.ac.jp
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Abstract
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Although we believed that the use of a polyester film drape for primary elective open sternum with delayed sternal closure made it impossible to record precordial electrocardiograms on the drape, we confirmed that it is possible to record electrocardiograms on an iodine-impregnated drape due to the iodine anion electrical conductibility.
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Introduction
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We applied an iodine-impregnated drape (Ioban 2 Antimicrobial Film; 3M Co, St. Paul, MN) for primary elective open sternum with delayed sternal closure, due to Ioban’s reported antibacterial effect [1]. Although, it has long been thought that recording of electrocardiograms (ECG), especially in the precordial lead, is limited when a drape is applied to the chest, due to the electrical conductibility of iodine, we hypothesized that iodine on the drape may assist the electrical flow from the skin to the surface of the drape, allowing ECG to be recorded on the Ioban.
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Technique
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We applied the Ioban on the volunteer’s chest wall and recorded the ECG (Fig 1 ). We found no difference in the electrical activity recorded from the chest wall through the precordial lead with or without application of the Ioban (Fig 2 ). Therefore, we applied the Ioban to 2 patients who required primary elective open sternum with delayed sternal closure for low output syndrome. We applied the Ioban to the skin closure without sternal stenting and put the monitoring electrode on the Ioban (it is possible to place the precordial electrode in the standard position). The ECG could be recorded continuously in all leads, just as it can after normal open heart operations, which is important in assessing the condition of the heart. However, precordial ECG cannot be recorded when using Steri-Drape 2 Incise Drapes (3M Co) on the chest wall. According to 3M Health Care Limited, the difference between Ioban and Steri-Drape 2 is the presence of the iodine–polyvinylpyrrolidone complex in the adhesive agent on the adhesive side of the polyester film of the former.
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Fig 2. (A) Precordial electrocardiogram recorded on the Ioban on the chest wall. (B) Precordial electrocardiogram recorded on the chest wall directly.
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We measured the impedance between the left arm and left leg and found that the impedance of Ioban on the chest was 1,247 ohms, whereas that of Steri-Drape 2 on the chest was infinitely larger, as measured by an EIM-105 Electrode Impedance Meter (General Device Co, Ridgefield, NJ).
We measured the iodine anion concentration (atomic conc.%) on the film surface of Ioban and on the adhesive side of the film (using the Electron Spectroscopy for Chemical Analysis; Physical Electronics, Inc, Eden Prarie MN) and found that is was 0.1 atomic conc.% on the film surface and 0.2 atomic conc.% on the adhesive side.
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Comment
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Use of Steri-Drape plastic film coverage after cardiac operations is one of the techniques for primary elective open sternum with delayed sternal closure [2–4]. However, recording of the precordial ECG on the drape has been considered impossible. We used Ioban because of its antibacterial effect. In using this type of drape, we discovered that it is possible to record the precordial ECG. The cause of this phenomenon is not yet clear. However, chemically it is well known that the iodine anion is a good electrical transmitter. The iodine anion concentration gap between the film surface and the adhesive side probably promotes iodine anion transfer from the adhesive side to the film surface, thus enabling electrical transmission. On the basis of our findings, the heart status of patients may be more easily followed, particularly in cases that required a polyester film drape on the chest such as that require elective open sternum or a left ventricular assist device. Under such conditions, we recommend the use of Ioban based on both its superior electrical conductibility and antibacterial effect.
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References
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Lewis D.A., Leaper D.J., Speller D.C. Prevention of bacterial colonization of wounds at operation: comparison of iodine-impregnated (‘Ioban’) drapes with conventional methods. J Hosp Infect 1984;5:431-437.[Medline]
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Hakimi M., Walters H.L., 3rd, Pinsky W.W., Gallagher M.J., Lyons J.M. Delayed sternal closure after neonatal cardiac operations. J Thorac Cardiovasc Surg 1994;107:925-933.[Abstract/Free Full Text]
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Furnary A.P., Magovern J.A., Simpson K.A., Magovern G.J. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg 1992;54:233-239.[Abstract]
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Van Son J.A. Primary elective open sternum with only Steri-Drape film coverage after cardiac operations in pediatric patients. J Thorac Cardiovasc Surg 1995;109:1262-1263.
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Abstract
Introduction
