TENS Machine Use

TENS MACHINE USE

Here are the instructions on how to use your rented Elle Tens 2 Machine. Please read this guide after picking your machine up from our office at 37 weeks. We recommend you test your unit prior to labour to ensure it works well, and you understand how to use it before your contractions start. You will need assistance from your birthing partner to help place the pads in the correct positions on your back once your labour begins.

Please note – The unit must be returned to the clinic by the end of the first week postpartum. 

Instructions for use

Quick Reference Guide…

If you are in labour, please use the quick reference guide set out below. It is however recommended that you read this entire guide in particular “Setting Up Your Elle TENS” to obtain the best performance from your unit. 

Before using the Elle TENS 2, please read the contraindications and warnings further down.

  1. Ensure the Elle Tens 2 unit is switched off
  2. Insert 2 x AA batteries in the compartment at the back of the unit (see figures 1 and 2).
  3. Insert the leadwire plugs into the top of the unit (see figure 3).
  4. Insert the pins at the other end of the leadwires into the sockets attached to the electrode pads. Do not remove the electrodes from their backing at this stage (see figure 4)
  5. Position the electrode pads on the body as indicated in picture 2 below. A pair of electrodes must be connected to each lead wire in order for you to feel any sensation. The electrode pads must be peeled away from their backing and placed directly on your body for you to feel any sensation.
  6. Make sure that the ‘boost’ button at the side of the unit is NOT pressed in. This ensures that the unit will start in the BURST 1 mode (see picture 1).
  7. Press the (on/off) to turn the unit on.
  8. Now push the (CH1 +) key until you feel a pulsating sensation.
  9. Repeat the same with the (CH2+) key.
  10. At the onset of a contraction press the ‘boost’ button for the additional surge of power needed to combat the pain.
  11. Release the ‘boost’ button once the contraction has passed and continue in the BURST 1 mode as before.
Picture 2
Picture 1

Equipment providing a particular degree of protection against electric shock particularly regarding allowable leakage currents having an F type (floating) applied part.

Please keep device away from sprays of water or rain.

How will the Elle TENS 2 Help Your Pain?

The Elle TENS 2 is an efficient method of drug-free pain relief. This powerful digital TENS unit is smooth, sophisticated and simple to use. In order to obtain maximum benefit, it is advised that you seek guidance from your midwife as well as reading this instruction guide.

TENS (Transcutaneous Electrical Nerve Stimulation) works by passing mild electrical impulses through the skin, via electrode pads, into the nerve fibres which lie below. The TENS impulses help your body produce its own pain killing chemicals, such as ‘endorphins’ and ‘encephalins’. The level of pain relief obtained varies from person to person. Some find that the Elle TENS 2 provides all the pain relief required during the whole of labour, whereas others find that other analgesics are also needed during the later stages of labour.

Frequently asked questions:

Q) When shall I start using my Elle TENS?

A) Use as early as you can after the onset of labour to allow time for your body’s pain-killing chemicals to rise.

Q) Can I try the Elle TENS before going into labour?

A) Yes, place 2 pads on your forearm to feel the different pulse sensations following the instructions on page 5.

Q) Can I combine the Elle TENS with other medication?

A) Yes, you can still use analgesics such as *N20 & Oxygen (also known as gas and air or entonox) or morphine.

*Please note entonox is not currently available at home or hospital due to the COVID-19 pandemic.

Q) Can the Elle TENS be used in hospital?

A) Yes. However, a midwife may ask you to switch it off temporarily.

Q) Can I use the Elle TENS if I am considering a water birth?

A) Yes, but not in the water itself.

When Should TENS Not Be Used?

General Precautions

  1. Do not use this unit without first reading these instructions.
  2. Do not immerse the Elle TENS 2 unit in water or any liquid. Do not use in the bath or shower.
  3. Do not place it close to any source of excessive heat or operate it in the presence of flammable gas.
  4. Do not drop this unit onto a hard surface.
  5. Do not attempt to open or dismantle the Elle TENS 2 unit.
  6. Only use the specified batteries and electrodes.
  7. If damaged, do not use. Return to your midwife.
  8. Remove the batteries when the Elle TENS 2 unit is not in use.
  9. Do not use TENS whilst driving or operating potentially dangerous machinery or while using the microwave.
  10. Keep out of reach of children.
  11. Do NOT place electrodes on or near the eyes, in the mouth, over the front or sides of the neck or across the head or the heart.
  12. Do NOT place the electrodes on varicose veins or recent scarring or over any area of broken, infected, inflamed or numb skin. Electrodes should generally only be applied to skin with normal sensation unless under medical supervision.
  13. Do NOT use in the presence of tuberculosis, malignant tumours, very high or very low blood pressure, high fever or acute inflammatory disease unless under medical supervision.
  14. A mild shock may be caused if one electrode is accidentally removed. In the event of this happening the unit should be turned off immediately.

Contraindications

  1. Do NOT use TENS before 37 weeks of pregnancy unless under medical supervision.
  2. Electrodes should only be positioned as recommended (see picture 2) unless otherwise stated by your midwife or medical adviser.
  3. Do NOT place electrodes on the abdomen (before birth), the front or side of the neck, or areas on the head, which could cause current to flow transcerebrally.
  4. Do NOT use TENS if you have a demand-type cardiac pacemaker or any other implanted electrical device.
  5. If you suffer from epilepsy, heart condition, any undiagnosed pain, or have any metal implants, or any doubts whatsoever consult your midwife.
  6. Do NOT use if you have an allergic reaction to the electrodes.
  7. Never use TENS to mask undiagnosed pain since this could require urgent treatment.

Warnings

  1. Electronic monitoring equipment (such as ECG monitors and ECG alarms) may not operate properly when TENS stimulation is in use.
  2. Skin irritation can occur following long term application.

Display Symbols and their Meanings:

Power Bar: This shows the output from 0 to 15 for both left and right channels. Each segment represents approximately 7% of the total output.

 Pressing the ‘Boost’ button at the top right of the unit activates the Boost mode. This function is used during contractions. The small arrow to the left of the word Boost will remain on, indicating the unit is in a continuous mode. There are two Boost modes available indicated by a 1 or 2. You can switch between them by pressing the Mode Button.

BURST is used at the onset of labour and in-between contractions. The small arrow to the left of the word Burst will flash in time with the bursting rhythm you feel from the Elle TENS 2. There are two Burst modes available indicated by a 1 or 2. You can switch between them by pressing the Mode Button.

BETWEEN CONTRACTION TIMER starts by pressing the Boost button, this automatically measures the time interval between your contractions.

MODE 1 and 2 – There are two mode ranges available each with a Burst and Boost function. See below for use.

Low Battery Indicator: This sign will start flashing when the batteries are running low. If this is the case, change both batteries. Please refer to #Figures 1-5 for instructions.

Opti-max: Indicates the Opti-max output. Each segment represents 20% of total Opti-max power. Please refer to page 8 for more details.

  Contraction Timer: Starts by pressing the Boost Button, this automatically records the duration of your contraction.

Pad contact warning: (safety cut out) This symbol will appear if any of your pads are not attached securely to the skin.

Setting up your Elle TENS:

The Assembly Stage

Make sure the unit is switched off.

a) Press and rotate the belt clip at the back of the Elle TENS 2 in either direction to reveal the battery compartment

b) Release the battery compartment cover and insert 2 x AA batteries (see fig 2), ensuring the positive (+) and negative (-) terminals are correctly positioned as marked in the battery compartment. Replace the cover.

c) Take two of the purple leadwires and insert each of the black jack plugs (at one end of each leadwire) into the sockets at the top of the Elle TENS 2 unit (see fig 3).

d) Now insert the pins (at the other end of the leadwires) into the sockets attached to the sticky electrodes. Do not remove the electrodes from the backing at this stage (see fig 4). NB. Each leadwire has a red and black pin. It makes NO difference which electrode they are attached to.

e) If you wish, attach the easy-release neck cord which enables you to hang the Elle TENS 2 from your neck whilst in labour (see fig 5).

Suggested Electrode Placement Chart:

The sticky electrode pads need to be placed in the correct position for maximum pain relief. It is preferable to obtain assistance from either your birthing partner or medical adviser when positioning the pads. Please read the following instructions carefully:

  1. Ensure the unit remains switched off. Carefully peel the pads from the plastic backing using your forefinger and thumb. Do not pull on the lead wires. 
  2. Position the top two pads (connected to the left socket CH1) approximately 4cm either side of the spine and 4-5cm above the imaginary navel line as seen in the diagram.
  3. Position the bottom two pads (connected to the right socket CH2) approximately 4cm either side of the spine and 4-5cm below the imaginary navel line as seen in the diagram.
  4. Electrodes can be used several times but the number of uses according to the condition of the skin varies. Replace the pads when they stop sticking to the skin. (NOTE: You will be provided with one set of pads in your rental and should not require any more than this).
  5. Continue stimulation for as long as necessary, unless you experience discomfort.
  6. If you stimulate for a number of hours ensure the pads do not become dry. If this occurs, switch off the unit, disconnect the electrodes, and apply a small drop of water to them.
Reference: Cluett E. (1994) SRN RM ADM PGCEA. Analgesia in Labour: A review of the TENS method. Professional Care of Mother and Child. Mar;4 (2): 50-2.

Using your Elle TENS:

a) You are now ready to start using your Elle TENS 2. Switch the unit on by pressing the on/off button. Ensure that the ‘boost’ button located at the top right of the unit is NOT pressed in. The Elle TENS 2 will always start up in BURST 1 mode.

b) Begin by pressing the CH1+ key. Each time you press this key, a small ‘half-moon’ shape will appear on the screen increasing in number and size as the intensity is increased. You will begin to feel a pulsating sensation which will burst in time with the small arrow flashing on the screen. Ensure that you increase the intensity slowly.

c) Repeat the previous step with the CH2+ key. You will now feel a sensation in both sets of pads.

d) BURST 1 (use between contractions): This is the first mode that you will use. It feels like a bursting, tingling sensation i.e. the pulses are off and on periodically. This mode will help to promote those all-important natural pain-killing chemicals known as ‘endorphins’ and ‘encephalins’.

e) BOOST 1 (use during contractions): When experiencing a contraction, simply press the ‘boost’ button located at the top right of the unit. The Elle TENS 2 will then switch automatically into the BOOST 1 mode for that extra surge of power required to combat the pain during contractions. This will feel like a continuous sensation.

f ) Once the contraction has passed, simply release the ‘boost’ button. The Elle TENS 2 will return to the original BURST 1 mode. Continue this cycle during your early stages of labour.

Using the Contraction Timer

The first time you press the Boost Button, the Elle TENS 2 will automatically trigger the Contraction Timer (CT). This can be seen in the bottom right of the display. This measures the duration of your contractions in seconds. Once the contraction has passed and the Boost Button is released, the unit will trigger the Between Contraction Timer (BCT) which measures the time between contractions. This can be seen on the bottom left of the display.

Recalling your contraction history

To recall a list of your last 5 ‘Contraction Times’ (CT) and ‘Between Contraction Times’ (BCT) press the CH1- and CH2- buttons simultaneously.  The last recorded set of BCT and CT times are shown as 1.

Use CH2+ to go back to previous sets (e.g. 2, 3, 4, 5) or forward again by pressing CH2- key. Recalling the contraction history will not interrupt the functionality of the unit. N.B. to avoid losing contraction history, do NOT switch the unit off. To return back to the original mode screen, (which will have continued counting in the background), press the CH1- and CH2- buttons together again.

The Mode Button

There are two mode ranges available on the Elle TENS 2, each with a Burst and Boost function.

Mode 1 (Burst 1 and Boost 1), which has been described above, is primarily used for the earlier stages of labour.

Mode 2 (Burst 2 and Boost 2) can be used when your labour advances and your contractions become more frequent.

Press the Mode button to switch between modes. You will see from the User Display, that the number on the centre right of the display will change from 1 to 2 (and vice-versa).

NB. Both modes are interchangeable and can be used according to your preference, not necessarily for the stage of labour you are in.

The Opti-max Key

This provides extra versatility to your Elle TENS 2. Increasing or decreasing the Optimax key will allow you to either heighten or lessen the level of pulse power transmitted to the electrode pads.

Pressing the OM key either + or – will increase or decrease Opti-max sensation, this is extremely useful for the final stages of labour when you need an extra surge of power.

There are 5 Opti-max levels: 50, 100, 150, 200, and 250μs microseconds.  The unit will always start up at Opti-Max 150μs, which is exactly half way between the highest and lowest setting. 

NB. The Opti-max key can be used according to your preference and not necessarily for the stage of labour you are in. The Elle TENS 2 starts up in BURST 1. The BCT only appears after one cycle of pressing the Boost button on and off.

Useful information

Continue stimulation for as long as necessary, unless you experience discomfort.

If you stimulate for a number of hours ensure the pads do not become dry. If this occurs, switch off the unit, disconnect the electrodes, and apply a small drop of water to them.

Always ensure that the unit is switched off before you remove the leads. Do not pull the wires. Always remove the jack plugs from their sockets by holding the plugs between the forefinger and thumb.

N.B. The Elle TENS can also be used as a standard TENS unit for relief of numerous conditions, including after pains and post operative pains. It is worth bearing this in mind if you have a caesarean section. Please seek medical advice first.

Troubleshooting Questions

Q) Why does the stimulation not appear to be as strong after you have used the Elle TENS for a while?

A) Increase the intensity, you may have become used to a lower setting.

Q) Why does the stimulation feel strong but ineffective?

A) You may need to reposition the electrode pads.

Q) Why does the stimulation not feel sufficiently strong even on a high setting?

A) The batteries may need replacing.

Q) What do I do if there is no stimulation, intermittent stimulation, or weak stimulation felt even with a new battery?

A) Check electrode contact. Check leads. Check batteries. Contact Babycare TENS.

References:

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