Diphoterine®
This is a patient and carers information leaflet designed to help patients and carers understand what Diphoterine® is, how it works and what to expect from the procedure.
Why do we need to irrigate chemical burns?
Our skin normal skin is mildly acidic with a typical PH being between 4.5 -5.5. When our skin comes in to contact with chemicals the PH of our skin is changed and this can cause significant tissue damage. Research shows irrigation decreases the PH change in the skin and limits the extent of the injury.
What is Diphoterine®?
Diphoterine® is a washing solution designed for eye and skin chemical splashes. Diphoterine® has amphoteric, chelating and hypertonic properties and as a result aims to minimise the development and severity of chemical burns.
Why use Diphoterine® instead of water?
The chelating and amphoteric properties of Diphoterine® allow it to bind chemically opposite compounds, limiting their ability to cause further damage. It is also hypertonic meaning it has a drawing out effect and can therefore assist to try and help remove some of the chemical that has already penetrated into the tissue. Comparatively, water is hypotonic and has very little drawing effect on the chemical, limiting its ability to draw the chemical out of the deeper tissues.
Why is Diphoterine® hypertonic?
Diphoterine® is hypertonic to try and help limit the penetration of the chemicals in to deeper tissues. The hyperosmolar pressure creates a drawing effect from the inside to the outside tissues: as a result the chemicals are then pulled out from the deeper tissue to the surface of the skin or eye. Through this action, decontamination of the affected area is enhanced and accelerated.
Why is Diphoterine® Amphoteric?
An amphoteric compound is a compound that is capable of binding opposing chemical substances such as acids, bases or oxidizers, reducing agents. As a result of the binding action, the chemicals are then ‘disabled’ and are unable to cause further damage.
The treatment process
To start decontamination, the affected area will need to be irrigated with Diphoterine® Solution. This will wash away any harmful residues and help stop any further damage.
If there is no Diphoterine® Solution, immediately available, use water or normal saline solution and then wash with Diphoterine® as soon as possible.
The Doctor or Nurse will then spray the affected area with a canister of Diphoterine®; they will continue to spray the area until the canister is empty, this typically takes around 10-15 minutes. The spray can be likened to a cooling spray and feels like a light mist covering the affected area.
Typically one canister will be used to decontaminate the affected area however the Doctor or Nurse may use their clinical judgement and decide to use multiple cans; some examples of indications for this are delayed first aid/ prolonged contact time or a large surface area has been affected.
Post-treatment
The Doctor or Nurse will then clean your burn/s and then may apply Diphoterine® soaked gauze. This will stay in place for 24-48 hours and is designed to neutralise any residual chemical.
After 24-48 hours the soaks will be removed and the wounds dressed according to their presentation.
The use of post-treatment soaks is at the discretion of the burns team and is dependent on the patient and burn injury.
Dressings
The dressings will be determined by the clinician’s interpretation of the wound. The possibility of surgery may be discussed with you and a plan made.
Contraindications
There are no known negative interactions with the different families of medicines or devices and more specifically with ophthalmic solutions used in chemical burn protocols. Diphoterine® is currently being tested for the treatment of chemical digestive burns but has not yet been validated. However, it has already been tested and classed as non-toxic if swallowed.
Do not use in cases of splashes due to white phosphorous.
Diphoterine® has a limited effect on hydrofluoric acid.
Side Effects
No side effects have been reported by the company’s vigilance system.
Washing with Diphoterine® may cause temporary ocular discomfort.
Further Information/Supportive Research
Diphoterine® was originally developed for use in chemical burns to the eyes with very strong, supportive research. It has since been adopted for the use in cutaneous burns in a wide variety of settings; the evidence is growing with some convincing results.
If you still have some questions about the product, treatment or procedures then please do not hesitate to ask one of the burns team.