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Use of bipolar scissors (For open and laparoscopic surgery) ----------------------------------------------------
Never cut tissues by a bipolar cut current. Cut tissues mechanically while coagulating them by the bipolar coagulation.
The sticking of the bipolar instruments for coagulation and vessel sealing -----------------------------
The sticking of tissues on the tips of instruments is a normal and not avoidable problem. It is possible to reduce as follows:
While using all instruments for coagulation or vessel sealing both clean their tips /jaws and wet or damp them as follows:
If possible, use instruments with no-stick ends.
Before and during use, clean the ends of all instruments and wet / damp them.
Wet them in a bowl with physiological solution before the use and after 3/4 deliveries of power.
Damp them by a gauze soaked in physiological solution before the use and after 3/4 deliveries of power.
If possible, irrigate the tissue by physiological solution and deliver the power intermittently without pressing the ends too much.
The specific use of the monopolar and bipolar instruments for laparoscopy ---------------------------
The use of these instruments require a special care! Apply the following warnings in addition to those detailed in previous paragraphs.
Always check the good insulation of trocar cannulas.
Use the instrument under visual control and, after each withdrawl; check that all parts are present.
Maintain a correct distance between the ends of the instrument and sensitive structures of the tissue.
Activate the current only if the ends of the instrument are in contact with tissues.
Never use, during the operation, a hot instrument (An instrument with hot ends) as instrument for preparing.
Never use currents for coagulation with automatic start/stop system.
When using bipolar instruments for coagulation and vessel sealing, do also the following:
Prudentially perform at least two coagulations / seals (to the left and to the right of the point to cut) and verify if vessels are
well coagulated / sealed before performing the cut.
Use of currents and powers ---------------------------------------------------------------------------------------------------------
When start using a new HF unit, check its performance without considering previous experiences with similar devices.
When start an operation with a new unit, set very low powers and then raise them progressively.
Always use the lowest possible power and never use a monopolar power higher than 100W when using neutral electrodes for pediatrics
and 50/70W using electrodes for new-born.
Use the bipolar mode when operating on delicate or much innervated tissues, on small portions of tissue, on cavities and when operating
on patients with pacemakers or similar implanted devices.
Use the bipolar mode if the positioning of the neutral electrode for the monopolar mode is difficult.
Remember that the use of too low powers can cause unexpected risks.
Try to follow the suggested working times, and avoid useless short-circuits between active and neutral electrodes.
Regarding powers, the device is provided with an automatic self-test system with self-checks both at the switching ON and
during the functioning, (See the point AUTOMATIC SELF-TEST SYSTEM AND PROBLEMS NOT DETECTABLE BY SELF-CHECKS.
The system blocks the functioning and informs users by ERROR CODES or acoustic/visual ALARMS in following cases:
If it detects wrong activations (For example if the user pushes two activation switches simultaneously).
In this case users can intervene by eliminating the mistake immediately.
If it detects failures that cause: Absence of output power /Anomalous power delivery.
In this case users can switch the device OFF and ON again (ask for technical assistance if the problem continues).
Therefore, if during use the device doesn’t deliver the power (The normal powers appear less efficacious), but it has
properly passed the self-check at the switching on and the systems do not signal problems by ERROR CODES or ALARMS,
do not both increase too much the power and think that the problem depends on the unit. Do as follows:
Check the good contact between the neutral electrode and patient’s tissues while using monopolar currents.
Check cables and connectors by bending and pulling them (They mainly break close to the instrument).
Check the assembly and the internal connections of all instruments, mainly if for endoscopy or laparoscopy.
Check the insulation of the blades of all bipolar scissors (If damaged by the sliding a short circuit occurs and the current to reach tissues).
Clean the tips of all electrodes and instruments (If dirty, the current doesn’t reach tissues).
Clean the joints of the bipolar instruments for laparoscopy (If dirty the current doesn’t reach tissues).
Specific problems (Minor surgery, Veterinary) ----------------------------------------------------------------------------.
During the use in minor surgery and the patient is not fully anesthetized, a phenomenon felt like “electrical discharge” can occur.
It is not a dangerous electrical discharge since HF currents can only cause burns, but it is a slight neuromuscular stimulation that is a
normal side effect of the HF current (mainly while delivering monopolar coagulations). To avoid / reduce it, do the following:
Use surgical gloves to insulate the hand.
If possible, avoid the contact with the ground (For example by using clogs, insulating chairs and so on).
While using HF monopolar currents in veterinary, the risk of unexpected burns either where the animal touches the operating table or
where operators place the neutral electrode is quite high because of that follows:
The fur does not allow operators to obtain the good contact of the neutral electrode (Operators have to cut it).
Sometimes animal dimensions do not allow the good positioning of the neutral electrode.
Many times operators cannot insulate the animal from the conductive parts of the operating table.
The disinfectants / liquids that come down through the fur produce anomalous paths of current that can cause burns.
To avoid or reduce this risk, do the following:
Apply very carefully all the warnings of this paragraph about the use of the neutral electrode.
If possible, use the bipolar coagulation (Forceps with large tips allow the obtaining of a very efficacious coagulation).
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