SAFE USE OF DIATHERMY RACHEAL AFOLABI, RN, RM, H. Dip. PERI-OPERATIVE NURSING, H.Dip. HEALTH SYSTEM MANAGEMENT

Diathermy is one of the most commonly used tool in the operating theatre

DEFINITION Diathermy is the generation of heat in body tissues by means of radiofrequency energy (passage of an electric current through the tissues). The energy is used to cut tissues, seal blood vessels and destroy unwanted cells by the deliberate application of intense heat.

Two basic patient circuits are used Monopolar Bipolar

MONOPOLAR During monopolar diathermy the patient forms part of the electrical circuit, only one side of the generator output is connected to the active electrode. The other side is connected to a large patient return plate. The plate provides a safe path for the current to pass back to the diathermy.

Completed Circuit 2. Electricity must complete the circuit, or it will not flow. The energy must be able to get back to "ground" (its place of origin). In this shot, the energy flows from the generator, to the patient via the electrosurgical pencil, through the patient, exits through the pad, and goes back to the generator.

BIPOLAR During bipolar diathermy the current flows between the tips of the forceps, one tip acting as an active electrode and the other as a return. The patient’s tissue acts as the conducting medium, through which the current will flow. One advantage with this type is that production of the cutting current is virtually impossible. The field of coagulation is limited to the contact area;

BIPOLAR (Cont.) the surrounding tissues are not damaged. There is no patient plate attached.

EFFECTS OF SURGICAL DIATHERMY CUTTING COAGULATION/DESICCATION FULGURATION

PATIENT PLATE/RETURN ELECTRODE A minimum conductive area of 10 sq inches is recommended. Plate must be kept in secure contact with the patient’s body surface.

SETTINGS ON ELECTRO-SURGICAL UNIT Blends setting Autocut Autocoag Users must ensure that they are familiar with all settings and their functions

TYPES OF PATIENT PLATES REUSABLE DISPOSABLE

DISPOSABLE PLATES CONDUCTIVE ADHESIVE PLATES Generally thin, lightweight & flexible Conductive adhesive which works like gel Continuous adhesive border

ROUTINE DAILY THEATRE CHECK This must include checking the electro-surgical unit to ensure that: - All cables & electrodes insulation are intact - Adequate supply of patient plates Functioning alarm systems Connections are all fitting securely Foot pedals are all present & working

THINK SAFETY!!!

POINTS TO REMEMBER IN PROPER PATIENT PLATE USE Ensure regular, planned preventative maintenance checks Any faulty equipment must be removed immediately Plates are single use Avoid placement near scars, implant sites or ECG electrodes A muscular well vascularised area is most suitable

POINTS (Cont.) Site must be clean, dry & shaved Protect skin integrity by ensuring pt is not resting on dispersive plate clamp The diathermy setting is determined by the surgeon Be familiar with normal power settings Do not allow fluid to pool at dispersive site Check pt contact & connection before commencing

POINTS (Cont.) Ensure pt is not in contact with any metal Place active electrode in a quiver when not in use Only aqueous fluids should be used for irrigation On completion of procedure, remove the plate carefully & inspect the skin Document use of diathermy in pt’s record

SUGGESTED SITES FOR PLATE PLACEMENT CALF UPPER ARM ABDOMEN MID BACK BUTTOCKS ANTERIOR & POSTERIOR THIGH

THINK SAFETY!!!

Pad Site Burn AORN Journal, March 1991 Why is this important? Here is an example of what can happen through the misuse of electrosurgery. This slide is of a four-year old little girl, who went in for a T&A procedure. She received a third-degree full thickness burn from an unmonitored pad. This was published in the March 1991 AORN journal. Understanding the basics of electrosurgery will allow you to prevent these types of incidents, not to mention the accompanying legal issues. AORN Journal, March 1991

HAZARDS OF ELECTRO-SURGERY ACCIDENTAL BURNS SURGICAL SMOKE MINIMAL ACCESS SURGERY ENDOSCOPIC SURGERY

CAUSES OF THERMOELECTRIC BURNS Poor patient plate contact Hair at the site of return electrode plate Break in the wire connecting the plate to the electro-surgical unit Detached return cable Ignition of flammable material on pt’s skin High voltage electrocution of the pt Abnormally high power setting

References 3M Health Care (2000) Safety in Surgical Diathermy 3M Health Care Ltd., England Wicker, P. (2000) Electrosurgery in perioperative practice. British Journal of Perioperative Nursing. Vol 10 (4).

Cont….. Electrosurgical Safety Guide, ConMed Corporation, USA.

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