AS MOHS Surgery Department Procedure
MOHS Surgery Cardiac Implantable Electronic
Device (CIED) with use of Electrocautery
Origination Date: 08/11/2014 (approval date)
Effective Date: mm/dd/yyyy (date posted to web)
Reviewed Date: mm/dd/yy
Revised Date: mm/dd/yyyy
Approved by: James Clark Huff Medical Practice Director Dermatology, Marianne Sherman Ambulatory Service Director of Nursing
Business Owner/Title: James Clark Huff, MD Medical Director Dermatology
Target Patient Audience: All patients with Cardiac Implantable Electronic Device
Policy Intent: “These procedures are informational and are not intended or designed to substitute the reasonable exercise of
independent clinical judgment by the practitioner in any particular set of circumstances for each patient encounter. They can be
used to create an approach to care that is unique to the needs of each individual patient.”
Settings for Application: UCH-Central-Ambulatory Services-Mohs Surgery
Accountability: Registered Nurse who has completed the competency for Electrocautery
Rationale for Procedure:
To ensure patient with a cardiac implantable electronic device (CIED) are not compromised with respect to their cardiac status during the use of
electocautery.
Description:
High frequency signals generated by electrocautery may interfere with implanted pacemakers or defibrillators. Contact the
manufacturer of the pacemaker and ask if there are any specific requirements regarding electocautery. Ensure the ground pad is
placed as far away as possible from both pacemaker unit and its associated wires. Confirm that the ground pad has good contact
with the patient skin, and that the ground pad is not over a tattoo which may have metal ink, or joint replacement hardware. Place
the magnet over the pacemaker prior to the start of electrocautery to keep interference to a minimum.
Procedure Process
PROCEDURE
Mail out MOHS preoperative packet
RN to call patient when preoperative paperwork received back to clinic
RN or MA checks in and places patient in operating suite. Ask if the
patient has a pacemaker or defibrillator implanted.
Bipolar cautery to be used on patients with CIED’s
Continuous pulse oximetry used during duration of electrocautery with
patients with CIED’s
Patients with a dependent pacemaker or defibrillator ALWAYS
have a Magnet placed over the device during cautery
KEY POINTS or PROCEDUREAL STEPS
Health History Form
Preoperative Instructions
Informational Letter
Attempt to contact the patient; if unable to make contact discuss and
educate the day of surgery
Confirms type of CIED
Verifies device brand/manufacture
Confirm cardiology contact information
If patient answers yes. Staff makes all in clinic aware of patient’s device
status. Implanted device highlighted on MOHs preoperative sheet. This
is not documented in Epic.
Electricity doesn’t pass through patient’s body, only through the tines of
the bipolar forceps keeping interference at a minimum.
Confirms a perfusing pulse on the distal extremity.
Creates asynchronous pacing. Verify pacing by assessing pulse
oximetry. Check manufactures pacing rate.
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MOHS Surgery Cardiac Implantable Electronic Device (CIED) with use of Electocautery
AS MOHS Surgery Department Procedure
Cautery tip should be kept 15 cm from the pulse generator and from
the tip of the intracardiac pacemaker lead.
If using monopolar cautery place return electrode on lower extremity.
Place pad opposite side of device. Do not place over metallic ink from
tattoo, scar tissue or any areas with large concentrations of adipose
tissue, (stomach or buttock).
Assess for poor profusion
Post-operative vital signs
It could disrupt the device normal function in an extreme case most
likely cause electromagnetic interference.
If a grounding pad was placed over scar tissue or tattoo it could lose the
effectiveness of conduction and the patient could suffer a burn at the
exit point of the electricity.
Check peripheral pulses
If vital signs are stable discharge home – If unstable report to physician.
Documentation:
The status of a patient with a CIED will be documented on a MOHs pre-procedure worksheet. Patient education will be
documented under education in EPIC. The patient’s vital signs will be documented in EPIC by the RN or MA who will make the
MD aware of the patient’s preoperative status. The MD will document in Epic the patient’s CIED status and how the patient
tolerated treatment.
Patient Education: (if applicable)
The patient with a CIED will be verbally educated on the use of electrocautery before the surgery as a part of their consent to treat
form. The RN can document this under education in EPIC and will document the post-operative vital signs and any further
documentation necessary.
Competency: (if applicable)
All employees new to the Department of Cutaneous Oncology must complete an orientation, which includes caring for the patient
with a CIED. In-services will be provided as needed.
Sources of Evidence /References:
1.
2.
3.
4.
George Crossley, Jeanee E. Poole The Heart Society (HRS)/ American Society of Anesthesiologist (ASA) Expert Consensus Statement on
the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient
Management. 2012: 1125,1128,1129,1139. Level of evidence 1
Garcia Bracamonte B, et al. Electrosurgery in Patients with Implantable Electronic Cardiac Devices (Pacemakers and Defibrillators) Actas
Dermo-Silfiliograficas. 2013; 104: 128-32. Level of evidence 5
El Gamal H, Dufresne, G. Electrosurgery, Pacemakers and ICDs: A Survey of Precautions and Complications Experienced by Cutaneous
Surgeons American Society for Dermatologic Surgery, 2001
Conversation on 5/19/14 with Caitlin Brateng, BS Cardiovascular electrophysiology device tech, and Sandra Morrell, RN Device Clinic
representatives listed the above step by step procedure. Level of evidence: Expert Opinion.
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MOHS Surgery Cardiac Implantable Electronic Device (CIED) with use of Electocautery
AS MOHS Surgery Department Procedure
MOHS Surgery Cardiac Implantable Electronic Device (CIED) with use of Electrocautery
Approval Signatures:
Signature
Marianne Sherman,
Printed Name
Director Nursing and
Professional Standards for
Ambulatory
Title/Facility/Department
Date of Signature
Signature
James Clark Huff, MD
Melissa Feig
Medical Practice Director
Acting Practice Manger
Date of Signature
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MOHS Surgery Cardiac Implantable Electronic Device (CIED) with use of Electocautery