Buyers’ guide
Electrosurgery tip cleaners
CEP 08006
April 2008
Contents
2
Introduction............................................................................................... 3
Technical considerations.......................................................................... 4
Operational considerations....................................................................... 5
Economic considerations ......................................................................... 7
Purchasing ............................................................................................... 8
Market review ........................................................................................... 9
Acknowledgements ................................................................................ 12
Appendix 1: Supplier and product details............................................... 14
Appendix 2: Evaluation protocol............................................................. 17
Author and report information................................................................. 18
CEP 08006: 2008
Introduction
3
Electrosurgery tip cleaners are single use devices designed to allow safe, effective cleaning
of electrosurgical pencil tips. They generally comprise a foam pad with an abrasive surface
and an adhesive backing.
During electrosurgery there can be a build up of eschar (charred tissue) on the
electrosurgical tip. This causes adhesion of the tip to tissue, increased electrical resistance,
reduced surgical effect and can serve as a fuel source leading to surgical fires [1,2,3].
Surgeons remove eschar by rubbing the electrosurgical tips on the tip cleaning pad. Tip
cleaners are normally stuck to a surface within the sterile field, such as surgical drapes or an
instrument tray.
Eschar build up can be minimised through use of appropriate generator settings and
technique during electrosurgery [4,5] (see page 5). Non-stick coatings (such as silicone) on
electrosurgical tips can also help to prevent eschar accumulating on the tip [3].
Consultation with stakeholders was carried out at the outset and used to identify the key
factors to consider when making purchasing decisions. Two types of testing were performed:
•
Objective testing was used to determine a) the adhesion of the pad to drapes b)
presence of an X-ray opaque strip. Objective testing of samples (see Appendix 2)
was performed by an independent testing organisation accredited by the United
Kingdom Accreditation Service and the results form the basis of the ratings given in
the Market review tables
•
User evaluation examined a) ease of use, b) removal of eschar from tip, and c)
damage to electrode tips. See Appendix 2 for further information. Results are
discussed in the technical and operational considerations.
This buyers’ guide contains guidance on technical, operational and purchasing
considerations for the use of electrosurgery tip cleaners. Stakeholders have identified these
considerations as important in purchasing decisions. A comparison of a range of devices
available on the UK market, including the test results, can be found in the Market review
section.
CEP 08006: 2008
Technical considerations
Adhesiveness
Tip cleaning pads are normally stuck to a surface such as a surgical drape, enabling the
surgeon or scrub nurse to clean the electrosurgery tip using only one hand. The
adhesiveness is important to ensure that the pad remains in place for the duration of the
procedure.
For single use drapes, the pad does not need to be removed at the end of the procedure.
Where reusable drapes are used, the pad must be removed at the end of surgery, prior to
laundering. Pads tend to stick better to single use drapes than reusable ones, and can be
easily peeled off. Where adhesion is very high some adhesive material may remain on the
drape.
X-ray opacity
X-ray opaque strips are incorporated into some tip cleaners to allow imaging verification in
the event of a lost pad. Pads are not intended to be placed within the patient, but are often
placed on drapes near the surgical site. The contrast between the pad material and x-ray
opaque strip should be good enough to ensure easy detection on an x-ray image. An
example image is shown in figure 1.
Special care should be taken when using a tip cleaner which resembles a cotton swab as
this may absorb blood, could be mistaken for a swab and inadvertently left in the operative
cavity. This would be a significant problem if the pad is not radio-opaque.
Figure 1
CEP 08006: 2008
4
Operational considerations
5
Eschar removal
The primary purpose of a tip cleaner is to remove eschar. This is achieved by scraping the tip
of the electrosurgical instrument being used across the abrasive surface of the pad. The
abrasive action produces some tip damage.
Reduction in eschar build up
Surgeons can reduce eschar build up by using cut or blend generator settings rather than
coagulation while cutting and by reducing power settings during desiccation procedures.
Excessive smoke production or tissue charring that pulls away when the electrode is
removed probably indicates that the power settings are too high. Decreasing the power
settings, combined with slightly increasing the time, is likely to give a more even desiccation
and avoid surface carbonisation (charring).
Spray Coagulation (or fulguration) is the use of a high voltage spark to the tissue from an
electrode that does not contact the tissue surface [4]. Using spray coagulation rather than
contact coagulation (or desiccation) may reduce eschar build up on the electrode tip [6].
Use with coated tips
The abrasive action of cleaning pads can damage the non-stick coating on coated
electrosurgical tips, reducing the non-stick properties and resulting in eschar build up. Nonabrasive cleaners can be used, removing some eschar whilst protecting the coating.
Generally products that did less damage to the silicone coating also removed less eschar.
Results from a user evaluation are included in the market review.
Abrasive surface
It has been reported that particles of the abrasive surface of tip cleaners may stick to
electrosurgical tips and enter the site of surgery [7]. Most pads have black abrasive surfaces,
making it impossible to differentiate visually between remaining particles of eschar and
detached abrasive grit.
CEP 08006: 2008
Operational considerations
Ease of use
Generally the abrasive surface is flat, and with firm foam backing. Where the surface is
contoured the tip digs into it when a back and forth abrasive action is used.
Where there is no adhesive area then both hands are required for tip cleaning, with the thin
foam pad held around the electrosurgical tip.
Instructions and training
These are not normally provided or considered necessary.
Figure 2. Examples of tip cleaners showing contoured and flat abrasive surfaces.
CEP 08006: 2008
6
Economic considerations
7
Electrosurgical tip cleaners are single use products. They are usually supplied in individual
sterile packaging, but some manufacturers can supply non-sterile tip cleaners for inclusion in
theatre packs to be sterilised at a later date. They do not require any special storage in
addition to standard surgical items.
Disposal would be in clinical waste bags and cost of disposal is according to weight.
A reduction in the use of tip cleaners may be achieved using improved electrosurgical
technique [4,5] and the use of non-stick coated tips [3].
Non-stick electrosurgical tips will be damaged if abrasive tip cleaners are used. Selecting a
tip cleaner which does not damage the coating (see Tables on pages 10 & 11) would be
desirable if surgical use causes the non-stick surface to be covered with eschar.
Figure 3. Tip cleaner in sterile packaging.
CEP 08006: 2008
Purchasing
8
Purchasing considerations
NHS Supply Chain (NHS SC) offers national contracts or framework agreements for some
products, goods and services. NHS Supply Chain has recently published a national contract
for Sharps Pads and Tip Cleaners which offers some of the products listed. Use of these
agreements is not compulsory and NHS organisations may opt to follow local procedures.
Sustainable Procurement
The UK Government launched its current strategy for sustainable development [8] in March
2005. The Strategy describes four priorities to progress sustainable development, in the UK
and in the world as a whole:
•
sustainable production and consumption – working towards achieving more with less
•
natural resource protection and environmental enhancement – protecting the natural
resources and habitats upon which we depend
•
sustainable communities – creating places where people want to live and work, now
and in the future
•
climate change and energy – confronting the greatest identified threat facing the
global community.
The strategy also highlights the key role of public procurement in delivering sustainability.
Reduction in use
Fewer electrosurgery tip cleaners may be required if generator settings and technique are
optimised during electrosurgery, to reduce eschar build up [4,5]. Non-stick coatings (such as
silicone) on electrosurgical tips can also help to prevent eschar accumulating on the tip [3].
Disposal
Contamination of tip cleaners with bodily fluids and tissue debris require their disposal with
swabs and other biological waste. They do not contain metal parts and are low cost.
Consequently these products do not warrant the expense of cleaning and decontamination
prior to disposal to enable recovery of raw materials.
CEP 08006: 2008
Market review
9
Tip cleaners supplied by 11 companies (14 products) are summarised on pages 10-11. The
market review tables contain a summary of user and objective evaluation results. Most
indicates the best performance.
results are given a star rating where
How to use the market review tables
Physical
Notation used
Length (mm)
External length of device in mm
Width (mm)
External width of device in mm
Thickness (mm)
Weight
Unpackaged weight of a single device in grams
Page 7
Pages 5 & 17
- Indicates non-stick coating is undamaged
Pages 5 & 17
Single use drape
adhesiveness
- Indicates adhesion to single use drape
Pages 4 & 17
Reusable drape
adhesiveness
- Indicates adhesion to reusable drape
Pages 4 & 17
Coated tip preserved
Evaluation
External thickness of device in mm
- Indicates removal of eschar
Tip cleaning
X-ray opaque strip
Ordering
Location for
further
information
Product code
Number in pack
List price / unit ex VAT
- indicates clearly visible on x-ray image
Pages 4
Product or ordering code
Number of devices in a pack as provided by supplier
Manufacturer’s list price per device, excluding VAT
Product specific information
All but two tip cleaners readily removed all eschar from the tip and damaged coated tips.
Medasil Cautery Tip Cleaner removed some pieces of tissue but not all eschar. It reduced
damage to coated tips, however some damage still occurred. It has a contoured surface
requiring a slightly different tip cleaning technique.
Covidien Microwipe Tip Cleaner removed some tissue only. It has no abrasive surface and
did not damage coated tips. It also has no adhesive properties and worked best when held
around the electrosurgical tip.
Small fragments of the tip cleaner material were observed on the diathermy tip on two
occasions during user evaluations when using the Medasil Cautery Tip Cleaner. It should be
noted that this pad is green and therefore the material is very evident. Other pads may also
deposit material but since the surfaces are black it would not be visible (see page 5).
Manufacturer comments: Aspen Surgical, manufacturers of AMS Cautery tip cleaner TC100
state “Our testing has shown that the adhesion level in our Cautery Tip Cleaner meets or
exceeds the aggressive requirements of today’s operating room setting.
CEP 08006: 2008
Physical
Market review
10
AMS
Aspen cautery
tip cleaner
ASM
Cautery tip
cleaner
Covidien
Cautery tip
Polisher
Covidien
Tipolisher
Covidien
Microtip
Wipe
Intelligent
Tip cleaner
J&J
Surgiste tip
Cleaner
Dark grey
Dark grey
Dark grey
Dark grey
White
Dark grey
Dark grey
Length (mm)
46
51
51
51
89
50
48
Width (mm)
43
50
50
50
89
50
48
Thickness (mm)
6.0
6.0
6.7
6.3
3.0
4.7
6.0
Weight
1.7g
2.3g
3.7g
3.7g
<1.0g
2.0g
2.0g
Single use drape
adhesiveness
n/a
Not tested
Reusable drape
adhesiveness
n/a
Not tested
Tip cleaning
Evaluation
Coated tip preserved
Ordering
X-ray opaque strip
Product code
TC100
30500
31142790
31142717
31142535
None
4315
Number in pack
100
200
100
240
100
200
36
List price/unit ex VAT (£)
0.28
0.65
0.93
0.67
1.15
0.40
0.94
CEP 08006: 2008
Physical
Market review
11
Leonard Lang
Skintact ESU
tip Cleaner
Medasil
Cautery tip
cleaning pad
P3 Medical
Cautery tip
cleaning pad
Pennine
Surgical tip
Cleaner
Squadron
Surgical tip
cleaner
Universal
Electrosurgical
tip cleaner
Unomedical
tip cleaner
Dark grey
Green
Dark grey
Dark grey
Dark grey
Dark grey
Dark grey
Length (mm)
46
51
51
48
47
51
45
Width (mm)
44
51
51
48
45
51
45
Thickness (mm)
6.0
8.7
5.7
6.0
6.0
5.7
5.3
Weight
1.7g
2.0g
2.0g
1.7g
1.7g
2.0g
1.3g
Product code
TC1001
CT1
CTC050
TC1000/100
TC1000/100
UN58200
PM0837
Number in pack
50
50
50
100
100
50
50
List price/unit ex VAT (£)
0.30
0.48
0.80
0.43
0.55
0.70
0.40
Tip cleaning
Evaluation
Coated tip preserved
Single use drape
adhesiveness
Reusable drape
adhesiveness
Ordering
X-ray opaque strip
CEP 08006: 2008
Acknowledgements
We would like to thank all the manufacturers and suppliers for providing samples for
evaluation free of charge. We also thank the stakeholders who helped us to prepare this
Buyers’ guide, in particular:
Jane Ashworth, Team Administrator, NHS Supply Chain, Chester
Jan Collins, Theatre Manager, Princess of Wales Hospital, Bridgend
Peggy Edwards, Patient Safety Manager (Wales), National Patient Safety Agency
Paul Fram, Technical Officer, SMTL, Princess of Wales Hospital, Bridgend
Gavin Hughes, Technical Manager, SMTL, Princess of Wales Hospital, Bridgend
Lorraine Kruger, Clinical Leader, Main Theatres, University Hospital of Wales, Cardiff
Susan Pirie, Professional Officer, Association for Perioperative Practice, Harrogate
Peter Phillips, Acting Director, SMTL, Princess of Wales Hospital, Bridgend
Alun Tomkinson, Consultant, University Hospital of Wales, Cardiff
Neil Warren, Manager, Welsh Institute for Minimal Access Therapy (WIMAT), Cardiff
Medicentre, Cardiff
Peter Willson, Consultant General Surgeon, Kingston Hospital NHS Trust, Surrey
CEP 08006: 2008
12
References
13
1. AORN. Recommended practice for electrosurgery. AORN Journal 2005; 81: 616-642
2. Massarweh N et al. Electrosurgery: History, Principles, and Current and Future Uses.
J Am Coll Surgeons 2006; 202: 520-530
3. ECRI. Ignition of Debris on Active Electrosurgical Electrodes. Health Devices 1998;
27: 367-70
4. MDA. Low/medium power electrosurgery review 2002. MDA 02037
http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=443&id=54116
5. MHRA. High power electrosurgery review 2004. MHRA 04080
http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=443&id=54115
6. Willson P. Personal communication. Consultant General Surgeon, Kinsgton Hospital
NHS Trust
7. Haigh P et al. Origin of Metallic Particles Resembling Microcalcifications on
Mammograms after Use of Abrasive Cautery Tip Cleaning Pads during Breast
Surgery: Experimental Demonstration. Radiology 2000; 216: 539-544
8. UK Government. Securing the Future: delivering UK sustainable development
strategy. TSO 2005. http://www.sustainable-development.gov.uk/publications/ukstrategy/index.htm
CEP 08006: 2008
Appendix 1: Supplier & product details
Supplier
Product
Order code
Advanced Medical Systems Ltd
PO Box 4
Banbury
OX17 1TQ
Oxfordshire
Aspen Cautery Tip
Cleaner
TC100
Cautery Tip Cleaner
30500
Tel: 01295 738244
www.advmedical.com
ASM Ltd
Brunel Science Park
Gardiner Building
Kingston Lane
Uxbridge, Middlesex
UB3 2TG
Tel: 01895 239121
www.asm-group.com
Covidien (formerly Tyco Healthcare UK)
154 Fareham Road
Fareham
Hampshire
PO13 0AS
Cautery Tipolisher
Cautery Tipolisher
Microtip wipe
31142790
31142717
31142535
Tip Cleaner
Unknown
Tel: 01329 224000
www.covidien.com
Intelligent Medical Supplies Ltd
The Poplars
Landican Lane
Upton, Wirral
CH49 5LJ
Tel: 0151 648 0955
Johnson & Johnson Medical Ltd
The Braccans
London Road
Bracknell
Berkshire
RG12 2AT
Tel: 01344 864000
www.jnjgateway.com
CEP 08006: 2008
Surgisite Tip Cleaner
4315
14
Appendix 1: Supplier & product details
Supplier
Product
Leonhard Lang UK Ltd
Unit 6, Frogmarsh Mill
South Woodchester
Gloucestershire
GL5 5ES
Skintact ESU Tip
Cleaner
Order code
TC1001
Tel: 01453 874130
www.leonhardlang.co.uk
Medasil (Surgical) Ltd
Medasil House
Hunslet Road
Leeds
LS10 1AU
Cautery Tip Cleaning
Pad
CT1
Cautery Tip Cleaning
Pad
CTC050
Surgical Tip Cleaner
TC1000/100
Surgical Tip Cleaner
TC1000/100
Tel: 0113 243 3491
www.medasil.com
P3 Medical Ltd (formerly Amba)
1 Newbridge Close
Bristol
BS4 4AX
Tel: 0117 972 8888
www.ambamedical.co.uk
Pennine Healthcare Ltd
City Gate
London Road
Derby
DE24 8WY
Tel: 01332 794880
www.penninehealthcare.com
Squadron Medical
Unit A, Ireland Industrial Estate
Griffen Close
Staveley
Chesterfield
Derbyshire
S43 3LJ
Tel: 01246 470999
CEP 08006: 2008
15
Appendix 1: Supplier & product details
Supplier
Product
Order code
Universal Hospital Supplies
George House Unit 6,
Delta Park Industrial Estate
Millmarsh Lane
Enfield
London
EN3 7QY
Electrosurgical Tip
Cleaner
UN58200
Tip Cleaner
PM0837
Tel: 0845 082 0182
www.uhs.co.uk
Unomedical Ltd
Thornehill Road
North Moons Moat
Redditch
B98 9NL
Tel: 01527 587700
www.unomedical.co.uk
CEP 08006: 2008
16
Appendix 2: Evaluation protocol
17
Technical Evaluation
The technical evaluation was performed at the Surgical Materials Testing Laboratory (SMTL).
Where sterile and non-sterile samples were supplied the sterile samples were used, when
possible, however no differentiation was made in the results.
A tip cleaner was placed on one end of a strip of drape and weighted down for 1 minute with
a 1Kg mass. The weight was then removed and the drape peeled back by a couple of
millimetres from the adhesive edge. The tip cleaner was then placed in the tensiometer jaws
and the drape material peeled back at a speed of 50mm/min. The limit of the load cell was
100N, in some cases this limit was exceeded. The same method was used for both
disposable and reusable drapes.
The results were presented as an average from three samples of each tip cleaner and given
star ratings according to the following table.
Star rating
Adhesiveness (N/mm)
0-0.49
0.5-0.99
1.0-1.49
1.5+
User Evaluation
Tip cleaners were evaluated by building up eschar on an electrosurgical tip until the tip was
observed to be sticking, using a sample of meat. The tip was repeatedly wiped on the tip
cleaner, and observations made as to the ease of cleaning, the removal of eschar from the
tip, debris surrounding the pad and ease of cutting after tip cleaning. Each pad was tested
three times and the mean score used to determine the star rating. No tip cleaner had
instructions stating that they were to be used with either non-coated or coated tips, therefore
all products were tested in the same manner.
The results for tip cleaning are based on how clean the electrosurgical tip was (by visual
inspection) after cleaning. The evaluator scored the following statement:
Statement: Electrode tip
remains black after cleaning
Score allocated by evaluator
Strongly
agree
1
Agree
Neither
Disagree
2
3
4
Damage to non-stick coatings on electrosurgical tips was assessed by rubbing a new coated
tip on the pad. Data from this test was observational rather than numerical.
Star rating
Tip Cleaning Mean
Score
Coated Tip
Protected
CEP 08006: 2008
1
2
3
4
Extensive
damage after
single use
Slight damage
after single use
Slight damage
after repeated
use
No damage
observed
Author and report information
Electrosurgical Tip Cleaners
Megan Dale, Jonathan Lane,
Dr Diane C Crawford
Clinical Engineering Device Assessment
and Reporting (CEDAR)
Cardiff Medicentre
Cardiff
CF14 4UJ
Tel: 029 2068 2120
Fax: 029 2075 0239
Email:
diane.crawford@cardiffandvale.wales.nhs.uk
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About CEP
© Crown Copyright 2008
The Centre for Evidence-based
Purchasing (CEP) is part of the Policy and
Innovation Directorate of the NHS
Purchasing and Supply Agency. We
underpin purchasing decisions by
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We are here to help you make informed
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CEP 08006: 2008
18