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Seven checks before using electrosurgery

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Update time : 2023-10-24 11:49:00
Electrosurgery is a surgical treatment method that uses the coagulation and cauterization effects of high-frequency current. The general effect on the skin is to conduct heat to the tissue, or to produce a thermal reaction in the tissue through electric current. Commonly used electrosurgical methods in skin surgery are electrocoagulation and electrocution, which are used in the same way as in general surgery, while electrocautery, electrodesiccation, and electrocautery can be used in combination with other treatments in dermatology.
Safety of electrosurgery 
Composition of monopolar electrosurgery: Monopolar electrosurgery generally consists of a host machine, an electrosurgical pen, a foot control switch and a negative plate (wire).
Working principle: Utilizes 300-500HZ high-frequency current to release heat energy and discharge to cut and stop bleeding of tissues. The current forms high temperature, thermal energy and discharge at the tip of the electrosurgical knife, causing the contacted tissue to quickly dehydrate, decompose, evaporate, and coagulate blood, thereby achieving tissue decomposition and coagulation to achieve the purpose of cutting and hemostasis.
Application scope:
Monopolar electrosurgers are widely used in surgery, dermatology, and dentistry, and can be used to cut different tissues according to their functions.
(1) Pure cutting function: mainly used for clear, precise and damage-free cutting of any tissue.
(2) Mixed cutting function: used for cutting any tissue and has good coagulation function.
(3) There are generally three types of coagulation functions:
a. Low-pressure contact coagulation (desicate/low): generally used for laparoscopic surgery and fine tissue coagulation.
b. Non-contact coagulation (fulgurate/med): effective for most tissues and suitable for most surgeries.
c. Spray coagulation (spray/high): used for large-area tissue oozing and forming a very shallow tissue coagulation layer.
Seven checks before surgery
1. Check the condition of the power cord; the power cord may be damaged due to slip knots, excessive pulling, or being crushed by wheels.
2. Check the accessories and connections; check the integrity of the connections. Disposable accessories are strictly for one-time use. It is prohibited to use damaged, broken or defective accessories. Confirm that all accessories are connected correctly.
3. Check whether the patient wears metal jewelry and has tattoos;
Rings, necklaces, earrings, denture rings, and vaginal piercings may be connected to electrical circuits, increasing the risk of burns. Tongue pins can damage the endoscope and hinder intubation in emergency situations. In tattoos, ink (especially red ones) often contains metallic components that may conduct electricity or become a conductor of heat. It is recommended to remove all pierced or non-pierced jewelry. If the jewelry cannot be removed, it is recommended to use bipolar technology first. When single-stage must be used, it is necessary to avoid the current loop flowing through the metal jewelry. Cover the jewelry with gauze to avoid direct contact between the skin and the jewelry. Do not touch the jewelry with the electric knife pen to prevent residual heat from being transmitted to the jewelry and causing burns.
 
4. Check whether the patient has a pacemaker installed.
What if the patient has metal implants, pacemakers, cochlear implants, or hearing aids? For patients with pacemakers or metal implants, high-frequency electrosurgery is prohibited or used with caution (can be used under the guidance of the manufacturer or cardiologist), or bipolar electrocoagulation may be used instead. If you need to use a monopolar electrosurgery, you should use the lowest effective power and the shortest time; the negative plate of the loop should be pasted close to the surgical site; when choosing the location of the negative plate of the loop, keep the main current circuit away from the metal implant; strengthen monitoring, Closely observe the patient's condition. For patients with pacemakers, bipolar electrocoagulation and low-power operation should be used first under the guidance of professionals to avoid loop currents passing through the heart and pacemaker, and try to keep the wires away from the pacemaker and its leads. Patients need to undergo relevant examinations individually after surgery. For patients with cochlear implants undergoing head and neck surgery, if there is no external cochlear reference electrode, single-stage cannot be used, and bipolar can be used. Bipolar contact with the implant is strictly prohibited. High-frequency alternating current leakage may interfere with the hearing aid receiving radio waves and may also damage the two-piece hearing aid, so it should not be worn during electrosurgery.
 
5. Check patient placement. The patient should not come into contact with conductive objects, such as operating tables and metal IV poles. The patient should be placed in an electrically insulating position, kept dry, pay attention to catheterization, and do not use wet sheets. Leakage current can flow to the electrosurgical generator through metal parts along the operating table and the ground.
 
6. Check whether the pre-operative disinfectant is fully dry. Disinfectants containing alcohol may be ignited by sparks when using instruments.
 
7. Check the use and application of negative plates;
 
The smaller the area, the greater the current density, the higher the heat generated, and the higher the risk. Aligning the surgical direction diagonally may result in localized high temperatures.
The midline must be aligned with the surgical area! For the single-piece negative plate, the long side faces the direction of the current. For the equipotential ring, the entire area of the negative plate is used. Therefore, the equipotential electric ring negative plate can be applied in any direction. The core principle of all measures: reduce the negative plate current density
In addition to the negative plate, the detection system provided by the electrosurgery host itself is also an important guarantee for safety. The negative plate is not attached to the tissue and the device displays a red light. Attach the negative plate and the impedance monitoring indicator light turns green.
Eight things to note during surgery
1 Pay attention to the single startup time
The continuous stimulation of high-frequency current will cause any negative plate to become hot (hot). The ideal situation is a 1:3 working state, that is, working for 1 second and stopping for 3 seconds. Even if it cannot be achieved, the equipment should be turned off during continuous surgeries to allow it to rest and dissipate heat.
2 Pay attention to standard use
The cutter tip needs to be tightly connected to the handle. Use a suitable protective cover for the tip of the electric knife to promptly remove the eschar formed on the cutter tip. Ordinary surgical gloves cannot provide sufficient insulation, so tweezers with insulation protection should be used.
3 Pay attention to the placement of equipment
The electrode handle should not be in direct contact with the patient's body or placed on a sterile towel on the patient's body. It should always be placed in an instrument tray or dedicated electrode cover.
4 Pay attention to clearing smoke
Surgical smoke refers to gaseous substances generated during surgery, also known as aerosols, burning smoke, diathermy plumes, etc., which are produced during surgical operations by high-frequency electrocautery blades, laser blades, ultrasonic scalpels, high-speed drills, It is caused by the destruction of saw blades and instrument burrs and the vaporization of tissue proteins and fats. Surgical smoke not only blocks the surgeon's vision, but also releases toxic and harmful substances into the air. It will cause symptoms such as headaches, eye and mucous membrane inflammation for operating room personnel, and may also cause long-term potential harm to human health. Therefore, care should be taken to remove surgical smoke. When surgical smoke is generated, smoke traps should be installed as close to the surgical area (within 5 cm) as possible without interfering with surgical activities, and at the same time ensure that the operating room smoke extraction system works normally during the operation.
5 Pay attention to oxygen accumulation
Avoid combustion in an oxygen-rich environment and maintain oxygen concentration at a safe level. Conscious patients with nasal cannula oxygen flow rates of 3 L/M or less are at higher risk with oxygen masks. For patients with tracheal intubation, the oxygen concentration should be reduced to 40% or lower. Oxygen concentrations greater than 40% are risky for combustion. Oxygen may accumulate in the head and neck, mouth, chest, and abdominal cavity. Therefore, airway burns should be prevented when electrosurgical scalpel or electrocoagulation is used for intra-airway surgery. Mannitol enema is contraindicated in intestinal surgery, and electrosurgery should be used with caution in patients with intestinal obstruction.
6 Pay attention to the alarm sound
If an alarm occurs during use, stop using it in time, check whether the negative plate of the circuit has been displaced or fallen off, and whether it is evenly and firmly pasted. If necessary, shut down the machine and replace it or re-paste it.
7 Pay attention to ECG monitoring
The ECG electrodes should be kept away from the surgical area and at least 15 cm away from the application electrodes to avoid current loops passing between the ECG electrodes and the heart at close range.
8 Pay attention to reducing magnetic field interference
Coupling effect refers to the phenomenon that there is a close mutual influence between the input and output of two or more circuit components or electrical networks, and energy is transmitted from one side to the other through interaction. In electrosurgical applications, the phenomenon occurs when the working cable (electrosurgical pen or electric hook) transmits energy to adjacent (closer) cables or metal instruments. The wire of the electric knife pen is wrapped around the fluorescent tube. When the electric knife pen is turned on, it can light up the fluorescent lamp that requires 220V voltage. So which of the following two ways to fix the lead of the electrosurgical pen is better?
after surgery
After the operation is over, adjust the output power to the minimum, turn off the power of the host, then unplug the monopolar electrosurgical cable, remove the negative plate of the circuit, and unplug the power cord. After the operation, use registration, clean and organize the electrosurgical equipment. After the operation, slowly remove the entire negative plate from the patient's body horizontally from the edge along the direction of the skin lines. After removal, observe and clean the local skin.
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