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Electrosurgery
2
References
AORN Standards & Recommended Practices, (2002)Denver: AORN
Publication.,Sec. , P!. 22"#22$.
%ra&, '&nt(ia. )lectrosur!er&: Princi*les and Practices. +ideo, Davis &
,ec-#"$"2
.ortunato, N., %err& & /o(n0s ntroduction to O*eratin! Room 1ec(ni2ue.
3t( ed., St. 4ouis: 5osb&#6ear %oo-, nc., '(a* 20, *. 7"7#7"$, 2000.
.uller 8,. Sur!ical 1ec(nolo!& Princi*les and Practice. 7rd ed.,
P(iladel*(ia: 9.%.Saunders 'om*an&, '(a*. "7, *!. "7$#":0, "33:.
5ee-er, 5. and Rot(roc-, 8., Ale;ander0s 'are o< t(e Patient in Sur!er&.
""t( ed., St. 4ouis: 5osb&#6ear %oo-, nc., '(a*. 7, P!. 30#37, "333.
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Terminal Learning Objective
Given a simulated Operating Room (OR) and
the necessary supplies and equipment,
Apply safety measures hen using and
inspecting an !lectrosurgical "nit (!#")
and equipment $efore, during, and after
surgery%
&A' (ited references%
)
Enabling Learning Objectives
A% Given a list of electrosurgery terms, match each
term to its definition &A' AOR* and +erry
and ,ohn-s (are of the .atient in #urgery.
+% Given a list of #afety factors, select the safety
factors involved in using the !#" &A' /uller
and +erry and ,ohn-s%
(% Given steps for preparation of the !#", prepare
the !#" prior to use &A' +erry and ,ohn-s%
0
Enabling Learning Objectives
1% Given the appropriate information, identify the
roles of the OR team during and after use of the
!#" &A' AOR*, +erry and ,ohn-s, 2 /uller%
!% Given routine cleaning procedures, select those
applica$le $efore and after the use of the !#"
&A' +erry and ,ohn-s, and /uller%
/% Given dispersive and active !#" electrodes,
demonstrate the steps for inspection,
placement, and connection to the !#" &A'
cited references%
3
Electrosurgery Terms and
Definitions
4 )lectrosur!er&
4 1efinition5 the use of radio frequency electrical current to cut,
coagulate or destroy tissue%
6 Alternating current%
6 (urrent enters the patient7s $ody%
6 8he circuit5 generator, active electrode, patient, and patient
return electrode%
http://66.45.30.237//static/pofe/pofes4.htm
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Electrosurgery
- Process
http://66.45.30.237//static/pofe/pofes4.htm
:
Electrosurgery Terms and
Definitions
4
)lectrosur!ical =nit
;
ELO A Electrosurgery
Terms and Definitions
4
!lectrosurgical "nit5 < generator, foot pedal,
cords% Active electrode and dispersive electrode designed
to safely deliver electric current through tissue%
4
(urrent5 /lo of !lectrons
4
Active !lectrode (+ovie)
4
1ispersive !lectrode (Grounding pad)
1=
Terms and Definitions
5of 10
4
'oa!ulation (Coag)*
Definition:clotting of blood by burning
the ends of vessels to control bleeding.
6
/ulguration and desiccation
4
'uttin!
6
1efinition5 electric current divides tissue ithout
coagulation%
6
current is a continuous aveform%
6
loer voltages required to achieve tissue vapori>ation%
11
Terms and Definitions
of 10
4 %lend>
6 com$ination effects of cutting and coagulating
6 dampened aveform that produces some hemostasis
during cutting%
4 5ono#*olar (uni*olar)
6 (urrent flos through the patient to the patient return
electrode%
6 Active electrode is in the ound%
6 .atient return electrode attached on the patient%
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Terms and Definitions
!of 10
Monopolar
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Terms and Definitions
"of 10
4
+ipolar
6
Active electrode and return electrode
functions at site of surgery% (/orceps
tines)%
6
Only the tissue grasped included in
electrical circuit% (current passes only
$eteen tips of forceps)%
6
*o patient return (dispersive) electrode
needed%
1)
Terms and Definitions
#of 10
Bipolar
<
%PO4AR
10
Terms and Definitions
10of 10
4
?"!#8&O* < 8rue or false
@onopolar electrosurgery requires the use of a
grounding pad%

ANSWER: True
13
ELO $
%afety &actors
4 5etallic 8e?elr&
6 Rin!s
6 %od& Piercin!0s
6 )arrin!s
4
.lammable Pre* Solutions>
6 Alco(ol
6 %etadine
6 Dura*re*
4
Se*arate circuits <or )S= and ot(er e2ui*ment%
19
%afety &actors
'of 5
4
Position cords to *revent accidents.
4
nvesti!ate re*eated re2uest <or
more current.>
1:
%afety &actors
(of 5
4
Do no (arm.
http://www.vallela!e"ucation.or#
1;
%afety &actors
)of 5
4
@uestion: 9(& do &ou t(in- t(e )S=
s(ould not be *lu!!ed into t(e same
circuit as ot(er e2ui*mentA
$nswer: %ossi!le interference to
vi"eo e&uipment' etc( possi!le
power "rain to share" e&uipment
lea"in# to "ecrease" effectiveness(
possi!le over loa" on circuit
resultin# in loss of power.
2=
%afety &actors
5of 5
4
?uestion5 8he surgeon repeatedly complains that the
tissue is not $eing cutAcauteri>ed and tells you to
increase the !#" poer settings, hat should you doB
$nswer: ). chec* the placement of the
#roun"in# pa"' 2. chec* that the patient is not
in contact with an metal on the +, ta!le or
positionin# "evices' 3. chec* the connections
!etween the pen an" the -./' 4. su##est trin#
a new active electro"e 0Bovie pencil1.

21
ELO *
Pre+aration of E%,
4 %e <amiliar ?it( manu<acturer0s manual.
4 '(ec- biomedical stic-er <or recent ins*ection.
4 Bave accessories availableC
6 Ada*tors
6 'ablesDcords
6 .oot *edal
6 PadsDPlates
4 '(ec- <or e;*osed ?ires.
22
Pre+aration of E%,
'of )
4
1est sound and li!(ts be<ore eac( use.
4
Set volume.
4
Protect <oot *edal>
4
Avoid s*ills or *lacin! <luids on )S=.
4
'on<irm *o?er settin! ?it( t(e sur!eon
be<ore )S= is activated.>
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Pre+aration of E%,
(of )
4
@uestion: 9(en t(e sur!eon tests t(e active
electrode <or audible res*onse, no sound is
(eard.
9(at s(ould &ou doA
$nswer: 3hec* that the volume
is turne" on an" lou" enou#h for
the sur#eon to hear.
2)
Pre+aration of E%,
)of )
4
@uestion: 1(at0s not it, no? ?(atA
$nswer: ,echec* proper placement of
the #roun"in# pa" an" all
connections.
20
ELO D
%*-,$ D,T.E%
4
ns*ect %ovie <or de<ects.
6
Band*ieces and cords
6
S*ecial attention to endosco*ic instruments
4
Secure %ovie in (olsterD'anister>
4
'lean %ovie ti* bet?een uses.
6
Scratc( Pad
6
S*on!e
6
%ac- o< -ni<e blade
4
Plume.
23
%*-,$ D,T.E%
http://www.lina4me"ical.com/linapa#es/elect5003.html
29
*.-*,LATO- D,T.E%
4 )nsure unit is in o<< *osition be<ore
connectin! cables.
4 '(ec- t(e bovie and !roundin! *ad cable
connections s(ould be clean and dr& and
ins*ected bot( at t(e *atient and t(e
mac(ine.
4 'over and *lace <oot *edal near t(e
sur!eons <oot.
2:
1ispersive electrodes
2;
*.-*,LATO- D,T.E%
'of "
4
Placement of dis+ersive electrode
/$ovie +ad0
6
'(ec- ?it( anest(esia *rovider.
6
Avoid *atient to metal contact.
6
'(ec- e2ui*ment <or dama!e.
6
'onductive material must cover *ad
com*letel&.
6
=se a**ro*riate siEe *ad.
6
Place *ad *rior to dra*es%
3=
*.-*,LATO- D,T.E%
)of "
4
Placement of dis+ersive
electrode/cont0
6
Place *ad close to o*erative site.
Avoid t(e <ollo?in!:
4
%on& *rominences.>
4
Bair& sur<aces.
4
Scar tissue.>
4
Pre#e;istin! s-in lesions.
4
5etallic im*lants and *acema-ers.
31
*.-*,LATO- D,T.E%
5of "
4
Placement of dis+ersive Electrode
/cont0
6
Pad must maintain uni<orm bod&
contact.
4
Avoid !a*s or bubbles
6
Do not *lace tension on cord.
32
*.-*,LATO- D,T.E%
of "
4
'(ec- bot( %ovie and dis*ersive
*ad connections.
4
%e alert to mal<unctions.
4
Duties <ollo?in! sur!er&.
6
1urn o<< )S= and dial to 0.
6
Disconnect all cords.
6
Remove *ad, ins*ect site.
33
*.-*,LATO- D,T.E%
!of "
4
@uestion: 1(e active electrode cord is
accidentall& cut on t(e sterile <ield. 9(at
s(ould be done and ?(o s(ould do itA
1(in- about t(is in terms o< t(e sterile
<ield.
,emove the "efective without
contaminatin# our fiel" an" ,eplace
it with a new active electro"e
3)
*.-*,LATO- D,T.E%
"of "
4
@uestion: 6ou are t(e circulator,
&ou see t(at t(e *atient0s s-in is red
and blistered ?(en t(e !roundin!
*ad is removed, ?(at s(ould &ou
doA
6otif the sur#ical team' particularl
the sur#eon' "ocument the in7ur' an"
report episo"e to the %$3/ staff.
30
ELO E
-O,T.1E *A-E O& E%,
4 'lean A9 manu<acture0s
recommendations and n<ection 'ontrol
*olicies
4 Discard *lastic ba! on <oot *edal.
4 'lean )S= and <oot *edal.
4 'lean and ins*ect all reusable items.
33
ELO E
-O,T.1E *A-E O& E%,
4
?uestion5 Cou are turning the OR over $eteen arthroscopies,
ater is everyhere%
#hould you remove the protective $ag from the !#" foot
pedalB
4
'hy do you thinD your anser is correctB
$nswer: 8es' the e&uipment must !e
completel cleane" !etween patients.
9nfection control an" safet issues.
39
Summary
8his lecture provided you ith the necessary
information to5
4
A% @atch each given electrosurgery term
to its given definition
4
+% #elect the safety factors involved in
using the !#"
4
(% .repare the !#" prior to use
3:
Summary
8his lecture provided you ith the necessary
information to5
4 1% 1istinguish the roles of the OR team during
and after use of the !#"

4 !% #elect applica$le routine cleaning
procedures $efore and after the use of the !#"
3;
?uestionsBBB
)=
?ui>
MATCH :
Active
electrode a. Accessor& used to direct electric
current <rom t(e *atient bac- to t(e
!enerator.

nactive
electrode

b. 'lottin! o< blood b& burnin! t(e
ends o< vessels to control bleedin!.

'oa!ulation
c. )lectric current t(at is intense
enou!( to divide tissue ?it( coa!ulation.

'uttin!
d. Accessor& used to direct electric
current to t(e sur!ical site.

d.
a.
b.
c.
)1
@ultiple (hoice

Confirm power settings for the ESU


with the:
a
. Scrub b. Circulator
c
. Surgeon d. Anesthetist
6
. o!ie pad should be placed as close


to the operati!e site as possible

a!oiding the following:
a
. Muscular areas b. Soft tissue
c
. Scar tissue d. uttoc"s area
Surgeon
Scar tissue
)2
@ultiple (hoice
7.S
elect the duty performed by the scrub

during the use of the ESU.
a. Turns dial to 0
b. Ensures cable connection is clean and
dry prior to plugging into ESU
c. Adjusts settings per the surgeons
re!uest
d. "nspects #o$ie acti$e dispersing unit and
cord for signs of defect
"nspects #o$ie acti$e dispersing unit and
c ord for signs of
defect
)3
@ultiple (hoice
%
. &rior to placement of grounding pad on the
patient' you should chec( )ith the*
a. Scrub
b. +irculator
c. Anesthetist
d. &atient
Anesthetist
))
,. Select the duty performed by the circulator
during the use of the ESU*
a. +lean #o$ie tip bet)een uses )ith a
scratch pad or sponge.
b. -emo$e grounding pad' inspect site for
possible burns.
c. +hec( both #o$ie and grounding pad
cables.
d. .isconnect all cords.
@ultiple (hoice
c. +hec( both #o$ie and grounding pad
cables.
)0
/0. "f flammable s(in prep solutions are used'
ensure s(in surface*
a. 0as been )iped )ith a clean to)el
prior to draping.
b. "s blo)n dry )ith a fan prior to draping.
c. "s completely dry prior to draping.
d. "s co$ered )ith a +hu1 before draping
@ultiple (hoice
c. "s completely dry prior to draping.

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