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Archive September 2018 XIX, No. 9

10 Tips for Safer Electrosurgery

Use these guidelines to keep both patients and staff safe.

Jaisa Olasky

Jaisa Olasky, MD, FACS


Jaisa Olasky, MD, FACS

DANGEROUS DEFECT Insulation failures aren't always this easy to see. And the smaller they are, the more they can damage tissue.

From collateral tissue damage and insulation failure to grounding burns and OR fires, a lot can go wrong with electrosurgery. And here’s the thing. Your surgeons might not even be aware of the dangers of using high-frequency electrical current to cut and coagulate tissue, let alone the principles of safe electrosurgery. A good place to start? Put these 10 tips into practice today.

1 Always use the lowest power setting possible to get the effect you want. This is something that many surgeons have never learned. To get the desired tissue effect, they almost reflexively choose the “coag” setting and turn it all the way up. Sure, it works, at least usually. The vessel stops bleeding.

But it’s actually the least safe way to operate. If you’re trying to achieve a nice homogeneous seal with coaptive coagulation, the “cut” setting actually does a better job.

Plus, all the things you might be inclined to worry about with electrosurgery are less worrisome with lower settings. For example, lower settings decrease the release of stray energy. And if you happen to have an unrecognized insulation problem, it’s going to be less of a danger at a lower setting.

2 Understand the true functions of cut and coag. The first time most surgeons use an electrosurgical pencil, they’re taught on the fly in the OR, either as a medical student or as a junior resident. The senior surgeon reduces electrosurgery to an either-or proposition: If you want to cut something, use the yellow (cut) button. If you want to have hemostasis and coagulate, use the blue (coag) button.

Unfortunately, not only is it not that simple, that’s not even totally correct. Maybe they should have different names, because cut and coag don’t always have a lot to do with the distinction between cutting and coagulation. What they really represent are different waveforms of energy. The cut setting delivers a continuous waveform, the coag an interrupted waveform set at a certain duty cycle, based on how frequently per minute the energy fires.

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