Electrocautery
Terms Related to
Electrocautery
• ECU electrocautery unit
• Cautery and Bovie are used
interchangeably to describe the
cautery pencil or active
electrode
• FYI: Bovie is the originator of
electrocautery surgery, hence
called a “Bovie” sometimes
• Electro- (electrical/electricity)
• Cauterize (stoppage of bleeding)
Electricity Terms:
Current, Volts, OHM’s Law
• Electrical Circuit
• Hot Wire -wire that connects to the
switch
• Neutral Wire –serves as pathway for
electrons to return to the energy
source, completing the circuit
• Ground Wire – separate wire that
safely conveys any leaking electrons
to the ground, preventing injury to
the patient or personnel
• Must have a ground wire to prevent
electric shock
Electricity Terms:
Current, Volts, OHM’s Law
•
•
•
•
•
•
•
•
Wall Outlets
110V generally
Mobile X-Ray = 220V
Surgical outlet must have three prongs in
surgery
First prong (positive)
Second prong (negative)
Third prong (ground)
Wall plates that are red are hooked up to
the hospital generator and you will plug
important electrical devices into those
outlets that are vital to the patient and
their surgery
Electricity Terms:
Current, Volts, OHM’s Law
Electrical Systems
1. DC (direct current)
• Flows in one direction from
negative pole to positive pole
• Flashlight is an example of a DC
system
2. AC (alternating current)
• Flow of current reverses
periodically
• One complete cycle occurs when
the current moves in one direction
then reverses its course
• One AC cycle is called a Hertz (Hz)
Electrosurgery
• Electrocautery and electrosurgery
do not mean the same thing (will
hear terms used interchangeably)
• ESU =’s cut and coag/ ECU =‘s coag
ONLY
• Electrocautery is using a heated
wire to burn the patient’s tissue (eye
cautery)
• Uses DC current, no electricity
enters the patient’s body
Electrosurgery
• Two types ESU: Bipolar and
Monopolar
• Bipolar used for delicate
procedures where there is
moisture and a potential for nerve
damage
• Active and Dispersive electrodes
are the tines of a two prong
forceps
• Monopolar is used for large
surgical areas
Electrosurgery
• Application or use of an
electrical current to cut or
coagulate tissue
• Uses AC current
• ESU Components:
• Generator, optional foot pedal,
cords, active electrode, and
inactive dispersive electrode
Electrosurgery
•
•
•
•
•
•
•
•
ESU Circuit:
ESU generator
Conductor cord
Active electrode (pencil)
Surgical site
Patient (not part of circuit with
bipolar)
Dispersive electrode (grounding pad
with monopolar other tine of forcep
with bipolar)
Conductor cord
ESU Generator
Electrosurgery Hazards
• Burns to the surgeon, surgeon
assistants, STSR
• Burns to the patient from poor
grounding pad placement, pad
becoming loose due to oils, hair, air
pockets, or prep-solutions
• Cautery plume: vaporized tissue
contains carcinogens, BBP, and
mutagens
• Smoke evacuators should be used to
counteract these hazards
• Contain an air and charcoal filter
Basic Electrical Safety
Guidelines
• Remove jewelry when operating equipment
• Secure long hair and loose clothing around power
equipment
• Wear PPE prn
• Use equipment for intended purpose only
• Never use equipment you are not trained to use
• Inspect equipment prior to use
• Disconnect power prior to maintenance on equipment
• TURN OFF equipment power prior to unplugging or
plugging in equipment
• Never disconnect a plug by pulling on cord (pull on plug)
• Hands should be DRY prior to handling equipment or
cords/plugs
• Keep equipment out of line of traffic to avoid injury to
person or equipment
• Tape cords down to floor if they are in traffic to avoid
tripping
Electrical Safety
Guidelines
• Do not use electrical equipment when you’re
touching metal or water
• Unplug electrical equipment before cleaning,
inspecting, repairing, or removing anything from
them
• Keep electrical equipment areas clean/free from
flammable materials
• Keep access panels and junction boxes clear
• Know where fuse boxes and circuit breakers are
• Make certain all electrical equipment is grounded
• Do not use water on electrical fires
• Report unsafe conditions/equipment to supervisor
or biomedical/engineering department stat (Know
policy of institution regarding damaged equipment)
Valleylab Generator
• Features of the
monopolar generator:
• Cutting and coagulation
settings available
• Bipolar available on left
of unit with separate
settings
• Settings average on 0-50
cut and 30-70 coag
(surgeon preference)
• Standard settings 30/30
• Constant increase
requests by surgeon
mean something is
wrong
• Troubleshooting
problems: Tip must be
checked, connections
checked, if cannot
resolve obtain a new
bovie pencil first,
change ground
(circulator) change
generator
Bovie scratch pad
For non-teflon tips
Bovie holster
Teflon tip and bovie cleaner
Pediatric Grounding Pad
Adult Grounding Pad
Non-disposable
Tips
Bayonet forcep
McPherson’s bipolar forcep
Disposable Ophthalmic Forceps
Place in sharps container at end of case
Bipolar Cautery Tips
And
disposable cord
EYE Cautery or High Temp Cautery
Battery powered
Used in Eye Surgery
or
Peripheral vascular surgery
When a hole is needed in a synthetic
Dacron graft
These cannot be cut as the material
will fray, so hole may be burned to seal
the area
Electrocautery Review
• Monopolar
• Current travels from
generator, to active
electrode (cautery
pencil), to patient
(wound), to inactive or
dispersive electrode
(grounding pad), back to
generator…
• All components must be
present to avoid injury to
patient and to utilize
device
• Grounding pad placement
must be on a fleshy, nonhairy, non-moist area
where it is firmly stuck to
skin
• Ground is placed by
circulator
• Bipolar
• Current travels tip (active
electrode) to tip
(dispersive electrode) and
is powered by a generator
• No grounding pad is
needed
• Utilized when a precise
cauterization is needed in
delicate procedures such
as ophthalmic and
neurosurgical where
precision is key
•
Can have a bipolar with
an irrigating port, seen
most frequently in neuro
procedures with a
Bayonet style forcep
(Malis Bipolar unit)
Monopolar Cautery
• Various tips available: long,
short, needle tip, teflon coated
• Come in various colors
depending on manufacturer
• May be hand cautery or foot
pedal controlled
• Grounding pads must be
appropriate size for patient
(adult and pediatric available)
• NEVER cut a grounding pad!
Tourniquets
1.
Go to this site http://www.tourniquets.org
and read:
•
tourniquet overview
•
use and care sections
2.
Also read in Textbook St for the ST
Tourniquet Components
• Esmark
• Tourniquet Cuff (sterile
disposable or clean nondisposable)
• Pneumatic tourniquet machine
Safety Precautions
•
•
•
•
Tourniquet inflation times:
1 hour for upper extremities
1 ½ to 2 hours lower extremities
Times exceeding these recommendations
put the patient at risk for nerve damage
and or tissue ischemia (poor
oxygenation/vascular compromise) which
can cause tissue necrosis
• Tourniquets may be deflated for 10
minutes and then re-inflated if necessary
Safety Precautions
Continued
• Tourniquet pressures:
• Must not exceed 50-75 mm/Hg
over patient’s systolic blood
pressure for upper extremities
• Must not exceed 100-150
mm/Hg over patient’s systolic
blood pressure for lower
extremities