Electrosurgery Safety and Techniques

Electrode Adhesive Pad

• Minimum Size: 100mm²
• Minimum Diameter: 1.2 cm

Electrosurgery: Patient Return Electrode

• Avoid Placing on Metal Implants: Could divert current, causing excessive heat
• Integrity Check: Ensure package is intact before use. Do not use if damaged.
• Safety Belt: Do not place belt over electrode or cord.
• Secure Connection: Ensure a secure return electrode to generator connection. A faulty connection could create an alternative current pathway, posing a danger.
• Documentation: Maintain records.

Bipolar Electrosurgery

• Current Flow: From generator to forceps with active tip and inactive tip. Returns to generator through inactive tip.
• Does not flow through the body, unlike monopolar electrosurgery.
• Safer for: Presence of implantable device like pacemakers or defibrillators.

Electrosurgery: Generalized Safety Factors

• Restrictions: Avoid use in mouth, trachea, around head, or pleural cavity due to high oxygen concentration, creating fire risk.
• Electrode Placement: ECG electrodes should be placed away from the surgical site to prevent burns.
• Jewelry Removal: Remove rings and other jewelry to prevent burns from diverted current.

Electrosurgery: Electrical Burns

• Greatest Hazard: Electrical burns are the primary risk associated with electrosurgery.
• Deep Burns: Deeper and more extensive than flame burns.
• Tissue Damage: Can cause widespread necrosis and deep thrombosis.
• Debridement and Grafting: May be required to manage the burns.

Electrosurgery: Additional Safety Measures

• Follow Manufacturer Instructions: Adhere to operating and maintenance protocols in the manual.
• Malfunction Handling: Label malfunctioning Electrosurgical Units (ESUs) as non-functional and send them for service.
• Smoke Evacuation: Protect patients and personnel from inhaling smoke generated during electrosurgery. Suction can help.
• Inspect Instruments: Inspect insulated instruments for breaks, as current leaks can cause burn risks.

Microsurgery

• Magnification: Procedure done under magnification, providing enhanced visual acuity of small structures.
• Specialized Techniques: Requires specific instrumentation and training.
• Vessel Sealing: Small vessels seal as tissue is divided.

Active Electrode

• Sterile Component: Directs current flow to the surgical site.
• Conductor Cord: Attached to the generator.
• Cord Management: Passed off the field by the scrub person and attached to the generator by the circulating nurse.
• Sterile Cord: Do Not Secure with Metal Instruments.
• Handpiece Storage: Keep the handpiece and active tip in a holder.
• Char Removal: Avoid scraping char with a scalpel, as it can cause debris discharge.
• Minimizing Damage: Use the active electrode to minimize damage to adjacent tissue.
• Disposable Components: Active electrode handpiece and cord are disposable. If reusing, inspect thoroughly.

Patient Return Electrode: Additional Safety Measures

• Electrode Placement: Close to the active electrode site, reducing current flow through the body.
• Electrode Location: Place on a large muscle mass after patient positioning.
• Surface Considerations: Avoid placing on hair or scar tissue, as it acts as an insulator.

Monopolar Electrosurgery

• Current Flow: From generator to active electrode, through the patient to the return electrode, and back to the generator.
• Safety Feature: Generator grounds the current. A break in the circuit activates an alarm.
• Power Setting: Surgeon determines current and power settings, which the circulating nurse adjusts.

Monopolar Electrosurgery: Patient Return Electrode

• Current Return: Current returns to the generator through an inactive return electrode attached to the patient.

Electrosurgical Unit (ESU) Components

• Generator: Produces electric current
• Foot Pedal: Controls the current flow
• Cord: Connects components
• Active Electrode: Directs current to the site
• Inactive Dispersive Return Electrode: Returns current to the generator

Electrosurgery: Principles

• Tissue Cutting & Coagulation: Electrical current used for both.
• Coagulation Effects: Extensive burning can cause necrosis.
• Wound Healing: Burning can devitalize tissue, hindering healing and increasing infection risk.
• Skin Incision: Not typically used for skin incision.
• Other Applications: Useful for fat, fascia, muscle, internal organs, and vessels.
• Muscle & Nerve Stimulation: Current passes through tissue without stimulating muscles or nerves.

Electrosurgical Unit (ESU) Generator

• Current Output: Produces three forms of current:
  • Coagulating Current: Intense heat to seal vessels.
  • Cutting Current: Continuous high-energy output for tissue separation.
  • Blended Current: Combination of coagulating and cutting currents, delivered in modified cycles.

This quiz explores essential safety factors and techniques associated with electrosurgery. It covers topics such as electrode placement, current flow, and precautions necessary to ensure patient safety. Perfect for medical professionals wanting to enhance their understanding of electrosurgical practices.