Theatres & Anaesthesia (H&SS Jersey): Diathermy competency document
Diathermy – Electrosurgery competency:
1.1
1.2
1.3
Understands the
hazards of
electrosurgery
(Q/D)





Assessor’s
signature
Date
Summary of evidence criteria to support competency
Pass /
Refer
Comp
Numb
er
Individual
Equipment
Competency
Demonstrates an
understanding of
the principles of
electrosurgery:
(Q/D)
Can identify the
function of the
different types of
electrosurgery
equipment and
uses
(Q/D)
Level
Name : …………………………………………………………………………Date: ………………………..
Electrosurgery / diathermy is used for tissue dissection and coagulation
during surgical operations.
Electrosurgery refers to the passage of high frequency alternating electrical
current (a.c.) through the body to achieve the desired surgical effect of
cutting, coagulation or fulgurating of tissue
Mono-polar: The patient forms a major part of the electrical circuit. An
active cable from the electrosurgery unit carries current to the monopolar
electrode (e.g.forceps). Current spreads through the tissue to be collected
by a patient plate electrode attached to the patient and returned to the
machine.
Bi-polar: Only the tissue grasped between the tips of a pair of bipolar
forceps forms the electrical circuit within the patient. The bi-polar forceps
incorporates 2 electrodes, either of which returns the current.
Unintentional burns:
o Problems with the return electrode if too small / poorly applied –
To avoid this: Split / divided plate electrodes should be used
(rather than standard patient plates) – split plates activate a return
electrode monitoring system and checks that the patient plate is
attached to the patient.
o Alternative site burns e.g. wedding ring touches side bar of table
(metal) – possible for leakage current to flow thru this route
causing an alternative burn under the wedding ring.
1
Theatres & Anaesthesia (H&SS Jersey): Diathermy competency document
1.3
Understands the
hazards of
electrosurgery
(Leakage current
burns)
(Q/D)
Leakage currents: The current is forced to return safely to the electrosurgery unit
via the patient plate – potential for alternative site burns caused by leakage
currents. Capacitator: Combination of 2 conductors separated by an insulator. A
capacitator can pass leakage currents. The insulation required to prevent leakage
currents would be too thick
Scenario example: Active cable draped along the floor. The capacitator is formed
between the metal core of the cable, the cable insulation and earth. Should another
earthed object (e.g.drip pole) touch the patient, the leakage currents will pass from
the active cable through the insulation to earth, flow back up the earthed object
through the patient and back to the electrosurgery unit. If contact area where the
earthed object touches the patient is sufficiently small, a burn will be created.
1.4
Minimal access
surgery – risks
(Q/D)
Best Practice to prevent occurrence leakage currents burns:
 Only activate the electrosurgery unit when the electrode is very close to /
in contact with the tissue
 Lowest power setting possible is used
 Manufacturers responsible for meeting guidelines to minimise leakage.
Inadvertent burns of internal organs and tissue:
 Direct coupling – when electrode touches another instrument which in
turn is touching tissue.
 Create a capacitator by passing an electrode through a cannula / trocar
– Dependent on size of cannula and its contact with abdominal wall: If
the metal cannula is of sufficient size and making good contact with
abdominal wall, this leakage current will be dissipated and no burn will
occur.
Best Practice: The electrosurgery unit should not be activated unless the
uninsulated part of the active electrode is in full view
2
Theatres & Anaesthesia (H&SS Jersey): Diathermy competency document
1.5
Direct coupling
(Q/D)
1.6
Accidental
activation (Q/D)
Insulation failure
(Q/D)
Electrode
temperature (Q/D)
Surgical smoke
(Q/D)
1.7
1.8
1.9
2.0
MHRA:
Electrosurgery &
pacemakers
(Q/D)
When electrode touches another instrument which in turn is touching tissue. The
1st electrode can activate the other instrument and create an unintentional burn on
the tissue it is touching
If the footswitch should become faulty or if footswitch is activated mistakenly –
(footswitches replaced and when in use not trapped under) table
If the coating applied to the electrode is compromised – can result in current
passing to another metal instrument / inadvertently burn tissue directly
After prolonged use the electrode tip will remain hot and if placed in contact with
tissue can create an intentional burn.
 Reduces visibility of the surgical site
 Noxious odours
 Contains airborne chemical and viral elements
 Potential danger for laparoscopic patients where surgical smoke is
concentrated in the cavity:
o Carbon monoxide toxicity
o Port-site metastases for cancer spread
o Visibility reduced
o Smoke evacuator with filter should be used
 May be dangerous if the return pathway incorporates the pacemaker – the
pacemaker might shut off leaving patient in heart block, or the pacemaker
might fire rapidly leading to ventricular fibrillation
 Bipolar preferred option – due to short return pathway
 If monopolar required:
o Patient plate should be placed as close as possible to the surgery site
and away from the direct line through the heart
o Magnets available
3
Theatres & Anaesthesia (H&SS Jersey): Diathermy competency document
2.1
MHRA:
alcohol based skin
preparations
(Q/D; O)
To reduce the risk of fire and skin burns whilst using diathermy, do not allow
pooling of alcohol-based skin preparations, or wicking into drapes or dressings.
Ensure the area has dried before use of diathermy
2.2
Routine safety
checks
(Q/D; S; O)





2.3
Set up equipment
for use
(S;O; Q/D)
2.4
Intra-operatively
(S; O; Q/D)
Medical engineering serial number / date of last electrical safety test / date of
last service
Mains electrical supply cable / cord – intact
Plate electrode – connecting cable insulation intact. Gel moist and intact on
plate. Check plates expiry date
Accessory cable / cords – monopolar / bipolor cables condition
Knowledge of alarms and appropriate corrective action
 Main function keys/ buttons / foot control pedals
 AC power inlet
 Choose correct accessories
 Can explain information displayed on the generator settings
 Diathermy pad attachment – optimum body sites / pad type
 Alcohol based skin preparations allowed to dry prior to draping
 Correctly attach and turn on equipment. Safe storage of diathermy
attachment in insulator holder.
 Use lowest possible power settings that achieve desired surgical effect
 Ensure electrical lead is not a tripping hazard
 If patient moved / repositioned, check electrode contact intact
 Do not coil electrode cords – increases leakage current
 Check buttons on finger switches for function and free action.
 Check all footswitches cables and connectors for condition. Check all
switches for correct function and free action
4
Theatres & Anaesthesia (H&SS Jersey): Diathermy competency document
2.4
2.5
2.6
Intra-operatively
(S; O; Q/D)
Peri-operative care
record (O; Q/D)
After use (O; Q/D)






Avoid ‘buzzing’. But, if ‘buzzing’ a haemostat is necessary, touch the
haemostat with the active electrode and then activate the generator
Keep active electrodes clean – eschar build-up increases resistance, reduces
performance and require higher power settings.
If the ESU alarms, check system to ensure proper function
Document exact anatomical pad position
Inspect patient return electrode site to be sure it is free of injury
Safe removal & disposal of consumables. Correct terminal cleaning.
Assessment tools: - Observed = O; Questioning / Discussion = Q/D; Simulation = S
Available Resource material:
1. O’ Reilly, Michael ‘Electrosurgery in perioperative practice’ (September 2010) AFPP Vol 20 (9)
2. MHRA electrosurgery e-learning module. Available from:
http://www.mhra.gov.uk/ConferencesLearningCentre/LearningCentre/Deviceslearningmodules/Electrosurgery/index.ht
m
3. Covidien electrosurgery e-learning module. Available from: http://www.valleylabeducation.org/pages/ed-esself.html
5