ENERGY-BASED DEVICES Many surgeons and staffers don't fully understand surgical energy science.
From direct heat burns and surgical fires to internal injuries and noxious fumes, a lot can go wrong during electrosurgery — especially if you don't fully understand the power you're holding. "There are certain scenarios that everyone should be aware of to help reduce the risk of an adverse event," says Thomas Robinson, MD, MS, FACS, professor of surgery at the University of Colorado School of Medicine in Aurora, Colo., and co-chair of SAGES' FUSE (Fundamental Use of Surgical Energy) program. Test your OR team's knowledge of electrosurgical risks with this 7-question quiz.
1. What is the most common complication when using a radiofrequency surgical instrument?
a. direct application
b. capacitive coupling
c. fire
d. surgical smoke
Show Answer
a. The most common injury when using radiofrequency devices is a direct heat or direct application injury, says Dr. Robinson. These injuries occur when the surgeon holds the tip of the activated, hot instrument too close to vital tissue, which is then unintentionally burned. "While it seems like this is an obvious issue, and one that should be easy to prevent, 30% of all surgical energy-based device complications reported to the FDA occur via this injury pattern," says Dr. Robinson. "But because it's not as headline-grabbing as surgical fires or capacitive coupling burns, it doesn't get as much attention." To help prevent this complication, remind surgeons and staff that they must remain vigilant to ensure the electrosurgical device's tip does not get too close to vulnerable tissue.
2. True or false: The safest electrosurgical modality is bipolar radiofrequency.
Show Answer
False. All electrosurgical devices have roughly the same level of risk and are safe to use if you follow the manufacturer's instructions for use and follow proper precautions, says Byron L. Burlingame, MS, RN, BSN, CNOR, a senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN). There are a few exceptions, though. "Alternative technologies should be used instead of monopolar electrosurgery if there is a high risk of fire or if there is an implanted medical device within the pathway between the active and dispersive electrodes," says Mr. Burlingame. To improve your staff and surgeons' safety with all electrosurgical devices, keep the following tips from Mr. Burlingame in mind: Always use the lowest possible power setting, follow the devices manufacturer's instructions for use at all times, do not bend or manipulate the active electrode tip and remember that only the operator of the device should use the foot pedal.
3. True or false: The difference between monopolar and bipolar electrosurgical instruments is that bipolar devices use a grounding pad while monopolar technologies do not.
Show Answer
False. Trick question. Monopolar technologies require the use of a dispersive electrode, often referred to as a grounding pad, says Dr. Robinson. When using monopolar devices, an active electrode — typically the tip of the Bovie pencil or other device — is used to apply the electrosurgical energy to the targeted tissue. The electrical current then passes through the patient to a return pad, and then back to the electrosurgery generator to complete the circuit. However, with bipolar instruments, the surgeon will use a set of forceps to hold the tissue, says Dr. Robinson. The electrical current passes from one side of the forceps, through the tissue and to the other side, and then returns back to the generator. Because the current is restricted to the tissue between the forceps, you won't need a dispersive electrode.
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