Archive September 2007 VIII, No. 9

Thinking of Buying...Electrosurgery Safety Devices

How to prevent internal thermal injuries during laparoscopic surgery.

Vangie Dennis

Vangie Dennis, RN, CNOR, CMLSO

BIO

Injury resulting from stray electrosurgical current during electrosurgery provides a strong case for malpractice suits. In fact, despite recent advances in technology, more malpractice cases are filed as a result of electrosurgical burns than any other surgical mishap - which explains why some malpractice insurers have increased their rates by 15 to 20 percent for surgeons who perform monopolar electrosurgical procedures. The number of cases that have actually gone to trial is likely dwarfed by the number of cases in which surgeons and insurance companies have settled claims out of court.

Clearly, we have a strong incentive to protect ourselves and our institutions from the financial and legal risks associated with such injuries. We need to understand and account for the risks of electrosurgery, particularly since 90 percent of today's surgeries implement it in some way.

While some approaches and tools are widely considered safer than others, keep in mind that each choice you make could compromise safety if you don't understand the characteristics of the waveforms and the various delivery systems. In short, there are recommendations for electrosurgery safety, but the incorporation of procedures, delivery systems and equipment must be considered together to optimize a patient-safe environment.

Which type of pad?
Let's being by reviewing the types of pads.

  • Capacitive return electrode. This creates a capacitive effect, where energy is dispensed evenly using the patient's body to dissipate the charge. Variables in pad placement, adhesiveness of the pad and overheating at the pad site aren't a concern with this type of pad system. However, there is a human error component. The operator still has to clean the pad properly, examine it and make sure there are no defects. Appropriate patient selection and recommendations from the original equipment manufacturer are also important in preventing a burn to the patient. Keep in mind that this pad is incompatible with active electrode monitoring, which, as we'll discuss later, is a desirable safety feature.
  • Non-monitoring conductive return electrode. This is less expensive, but the plate can't monitor skin resistance, thus putting the patient at risk for potential site burns. If the contact of the plate doesn't adhere properly to the patient's skin, the electrical resistance increases and the electrosurgical system isn't notified that the plate has become detached. Unless you smell the burning, you might not realize you've burned the patient until the end of the procedure. These plates aren't used frequently and there's a reason. Imagine it as a car with no seat belt. Sure you can drive it, but would you want to? The majority of electrosurgical systems on the market today have software that is only compatible with a monitoring plate.
  • Contact quality monitoring plate. Commonly referred to as split pad technology, this plate monitors the skin's surface and measures its resistance. If the plate detects situations such as too much hair on the pad site or if it detaches from the patient, an alarm will go off. Most ESU systems have the ability to only accept a split system, but buyer beware: Various types of radiofrequency generators don't have monitoring systems and are compatible with either type of plate. This variable in hookup can lead to human error with regard to a potential burn if you don't consider all variables for plate placement.
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