ESU Review Student Copy PDF

ESU RPN: Postgraduate Perioperative Program Learning Outcomes Understand the term Electrosurgery and Electrocautery Describe how monopolar and bipolar and argon energies differ Understand ORNAC Standards relating to safety and placement of dispersive pads on the patient....

ESU RPN: Postgraduate Perioperative Program Learning Outcomes Understand the term Electrosurgery and Electrocautery Describe how monopolar and bipolar and argon energies differ Understand ORNAC Standards relating to safety and placement of dispersive pads on the patient. Describe the potential hazards of electrosurgery. What is ESU Electrosurgical Unit (ESU) Uses electricity to cut and coagulate tissues during surgery Can be used in open and minimally invasive surgeries (MIS) Principles of Electricity Current – flow of electricity Voltage – the force that moves the electrons Impedance – the opposition met by the electrons that resist/impede the flow Direct Current – electrons flow in one direction through a wire **wire become hot and when comes in contact with tissues creates the burning or coagulation outcome Alternating Current – electrons flow back and forth In the OR … Electrosurgery in the OR uses Alternating Current (AC) The current enters the patient’s body which becomes part of the circuit Voltage can be increased or decreased The energy flows in a closed loop or circle manner Electrosurgery Unit Monopolar Monopolar Tips Blade Needle Loop Short and Long Bipolar Bipolar Tips Foot Pedal Electrosurgical Modes Monopolar Two buttons used to activate the system Blue – coagulation mode Yellow – cutting mode Monopolar Electrical energy flows from: Generator → Active electrode (activated by the surgeon) → patient Tissue = impedance Controlled heat is generated and coagulation occurs Energy then goes to the dispersive electrode pad Energy from the pad is returned to the generator Circuit complete Generator→ Active Electrode→ Patient→ Dispersive Pad→ Generator Dispersive Electrode Pad Also called Patient Return Electrode (PRE) Adhesive (one-time use) pad Applied on a well vascularized area (i.e. thigh) Place pad close to surgical site Avoid areas with excessive hair, dry skin, or adipose tissue Pad does not allow energy to be concentrated and create heat PREVENTS PATIENT BURNS! Dispersive Pad Cautery Pad Grounding Pad Capacitive Pads “Megadyne Pad” Reusable pad placed on the OR table that the patient lies on Covered with sheet Sheet will not impede effectiveness i.e. for patients with large body surface area burns Smoke Evacuator Used with monopolar cautery to remove smoke/plume from cauterized tissues Protects surgical team from inhaling carcinogens Bipolar Electrosurgery Uses Coagulation ONLY Lower settings Dispersive pad not required Requires a foot pedal Current flows between the two prongs only “Exit” point is from the second prong which brings the current back to the generator ESU in Endoscopic Surgery Both Monopolar and Bipolar electrosurgery are used in endoscopic (MIS) Foot pedal is required for both mono and bipolar Risks Insulation Failure The insulated cover may become damaged over time. Electrical current may escape and burn surrounding tissue Risks Direct Coupling Active electrode accidentally touches a non-insulated metal instrument (metal to metal) Electrical current flows from one to the other and then to surrounding tissue → unintentional burn Risks Capacitive Coupling Occurs when an electrical current is transferred from one conductor to another conductor surface (i.e. trocar or tissue) Can occur even if insulation is intact! Hybrid instruments (plastic and metal) may be used to minimize this Use lower voltage settings and intermittent activation vs prolonged Argon Enhanced Electrosurgery Combines argon gas with electrosurgical energy Improves the effectiveness of the current PROS Rapid coagulation Decreased blood loss Reduced plume CAUTION – over inflation of abdomen and addition of argon gas = risk of gas embolism! Electro Thermal Sealing Devices Ligasure - Bipolar vessel https://www.youtube.com/watch?v=26cMx8LWk_A ORNAC Scrub Role Provide a clean and dry holster for the handpiece (cautery holder) Be aware of indications that power settings may need to be increased →What are some?? Ensure cords are not tangled Ensure cords and handpiece are not damaged Clean active electrode tip with scratch pad (PIC HERE) Prevention of Patient Complications Inspect instrument insulation Use lowest power setting Use low voltage waveform (cut) Bipolar use when appropriate Use quick and intermittent activation (“buzz”) Do not activate close to or directly with another instrument