P12/37 E-IM54f
ELECTROSURGICAL TECHNIQUES
General
4.14 When using electrosurgery, it must always be
remembered that its purpose is to cut, destroy or modify
tissue. This can occur at any point on the body where the
concentration of electrical current becomes sufficiently
high. Under fault, or misuse conditions, this current
concentration can occur on points on the body other than
the desired operation site and can cause burns.
4.15 To help reduce the possibility of such accidental
burns, the unit is fitted with a leakage limiting circuit in the
monopolar section. This circuit detects the conditions that
may lead to an increased possibility of accidental burns
from leakage and limits the leakage current accordingly.
The HF leakage limiter does not generate an alarm. In
addition, the following paragraphs give guidance for the
safe use of the electrosurgical unit.
4.16 With monopolar electrosurgery, the surgeon uses a
single point electrode to concentrate high frequency electric
current in the body tissues close to the electrode tip. If the
operating site is linked to the bulk of the body only by a
tissue path of small cross-sectional area, e.g. Fallopian
tube or penis, the surgical effect of the electrosurgery can
extend along it from the electrode with undesirable results.
4.17 Normally the surgeon will have ensured that the
operating site is bounded by a bulk of tissue into which the
current can disperse, so that the cut or coagulating effect
is limited to the tissues close to the electrode. The current
then disperses into the body and leaves it by way of the
relatively large plate electrode, having passed harmlessly
through any intervening tissue and organs.
4.18 In contrast, with bipolar electrosurgery there is no
plate electrode and the surgical effect occurs between the
tips of a pair of insulated bipolar forceps held by the
surgeon. The legs of the forceps constitute two
electrosurgical active electrodes.
Monopolar Electrosurgery
Plate Electrode
4.19 The plate electrode is also known as a neutral
electrode, passive, return, dispersive, indifferent or patient
plate electrode or simply as the ‘pad’.
4.20 Always use a plate electrode of proven technical
design and safety, and in strict accordance with the
application instructions issued with the plate electrode.
Burns at the site of the plate electrode are the most
common form of electrosurgical accident. Maximum
contact with the patient's skin must be maintained
throughout the surgical procedure. The following points
should also be noted:
♦ Do not apply any plate electrode over bony
protuberances, metal implants, folds of skin, scar
tissue, hairy areas, any form of skin discoloration, an
injury, or to limbs with restricted blood supply.
♦ Do not apply the plate electrode adjacent to ECG
electrodes and cables, or to an area where fluids
could pool.
♦ With babies and small children the plate electrode
should always be applied to the trunk section of the
body to give maximum contact with the skin. It is
unsatisfactory to attach the plate electrode to small
limbs where overlap of the plate electrode ends can
occur.
♦ Subject to application instructions, the plate electrode
should be on a smooth, resilient, muscular site well
supplied with blood vessels and as close as possible
to the operating area. The site should be clean and
dry, and shaved of excessive hair. The plate electrode
should be securely attached with its whole area in
contact with the patient’s body.
♦ Do not cut or modify the plate electrode in any way.
♦ Do not reuse disposable adhesive plate electrodes,
as adhesive failure could occur.
4.21 Adhesive plate electrodes (REF 83-122-42 and 83-
122-46) with detachable cables, should only be used with
a connector cable (REF 83-122-93) that requires complete
insertion of the connector tab. This ensures that contact
between the tab and any conductive object cannot occur.
Footswitches
4.22 Footswitches (REF 83-581-09 and 83-581-13 for
yellow, or REF 83-581-17 and 83-581-25 for blue, or twin
footswitches REF 83-109-39 and 83-109-47) must always
be under the direct control of the surgeon or the designated
assistant. Precautions must be taken to prevent
footswitches contacting the operating table base, castors
of trolleys, or other equipment under which they could be
trapped in the ‘on’ position.
4.23 During a surgical procedure and when the power
output is not activated, check that:
♦ The green ‘mains’ supply lamp is ‘on’.
♦ The bipolar and monopolar (cut and coag) power
activated LEDs are ‘off’.
♦ The audible ‘running tone’ is ‘off’.
Active Electrode Handles
4.24 During surgery, when an active electrode handle
(REF 83-140-20 without cable, or REF 83-141-01,
83-141-36, 83-141-28 and 83-141-44 with cable) or
fingerswitch (REF 83-582-06, 83-583-97 or 83-585-94) is
not in use, it should be put in an electrosurgical quiver
(REF 83-186-38) or similar receptacle. Do not put the
handle or fingerswitch:
♦ On the patient drapes.
♦ With other instruments.
♦ On the electrosurgical unit cabinet or on any other
theatre equipment.
This will further reduce the possibility of electrosurgical
burns due to accidental activation of the electrosurgical
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