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Electrosurgical Cautery Unit Machine

Monopolar diathermy is the emitance of the HFAC from the diathermy via an active electrode through the patients body tissues and then returned back to the diathermy machine via a dispersive electrode (patient return pad)

Bipolar diathermy is the emitance of the HFAC from the electrosurgery diathermy down one prong of a bipolar forcep through the tissue that has been placed between the forcep tips and returned to the diathermy via the second prong. Bipolar diathermy does not require a dispersive electrode (patient return pad).

Background

Surgical instrument india has three effects on body tissue:

  • cut - generation of heat destroys tissue cell
  • coagulation - tissue cells contract to increase normal clotting
  • fulguration - cell walls destroyed through dehydration

Each of these processes generates smoke plume which contains:

  • chemical by-products (eg toluene, acrolein, formaldehyde, benzene and hydrogen cyanide)
  • intact cells, cell parts and intact viral DNA
  • viable bacteria, including mycobaterium tuberculosis, have also been cultured

To minimize associated health hazards, specially designed smoke evacuation systems should be used where available and surgical filtration masks donned for all surgical procedures.

Prior to use

The Electrosurgery Unit (ESU) should only be use by members of the peri-operative team deemed competent.

  • The ESU should be inspected and safety features tested (eg lights, activation patient return electrode sound indicator) before each use
  • All cables and electrodes must be checked prior to use to ensure insulation is intact
  • Any problems must be reported to the Biomedical Engineering Department immediately.
  • The volume of the activation sound indicator should be maintained at an audible level
General use

The diathermy surgery should be protected from spills. Fluids should not be placed on top of the ESU

The dispersive electrode should be the appropriate size for the patientís weight and an electrode should never be cut to size
Only those active electrodes recommended by the manufacturer should be used. If an adapter is used it should be one that is approved by the manufacturer and does not compromise the generator's safety features.
After the patient is positioned on the operating table, the dispersive electrode should be placed on a clean, dry intact skin surface over a large, well perfused muscle mass

The dispersive electrode should not be placed over.

  • a bony prominences
  • implanted metal prosthesis
  • areas distal to a tourniquets
  • scar tissue
  • hairy surfaces
  • pressure points/areas

The electrode should be positioned as close to the operative site as possible
The dispersive electrode should be connected to the ESU prior to draping to ensure adequate contact & then the lead disconnected from the ESU temporarily to allow for the draping of the patient and the positioning of the surgeon