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

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

3. 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.

4. Two basic patient circuits are used
Monopolar
Bipolar

5. 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.

6. 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.

7. 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;

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

9. EFFECTS OF SURGICAL DIATHERMY
CUTTING
COAGULATION/DESICCATION
FULGURATION

10. 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.

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

12. TYPES OF PATIENT PLATES
REUSABLE
DISPOSABLE

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

14. 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

15. THINK SAFETY!!!

16. 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

17. 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

18. 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

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

20. THINK SAFETY!!!

21. 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

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

23. 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

24. 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).

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

26. THANK YOU FOR LISTENING