Electrocautery

1. Electrocautery

2. Terms Related to Electrocautery • ECU electrocautery unit • Cautery and Bovie are used interchangeably to describe the cautery pencil or active electrode • FYI: Bovie is the originator of electrocautery surgery, hence called a “Bovie” sometimes • Electro- (electrical/electricity) • Cauterize (stoppage of bleeding)

3. Electricity Terms: Current, Volts, OHM’s Law • Electrical Circuit • Hot Wire -wire that connects to the switch • Neutral Wire –serves as pathway for electrons to return to the energy source, completing the circuit • Ground Wire – separate wire that safely conveys any leaking electrons to the ground, preventing injury to the patient or personnel • Must have a ground wire to prevent electric shock

4. Electricity Terms: Current, Volts, OHM’s Law • Wall Outlets • 110V generally • Mobile X-Ray = 220V • Surgical outlet must have three prongs in surgery • First prong (positive) • Second prong (negative) • Third prong (ground) • Wall plates that are red are hooked up to the hospital generator and you will plug important electrical devices into those outlets that are vital to the patient and their surgery

5. Electricity Terms: Current, Volts, OHM’s Law Electrical Systems 1. DC (direct current) • Flows in one direction from negative pole to positive pole • Flashlight is an example of a DC system • AC (alternating current) • Flow of current reverses periodically • One complete cycle occurs when the current moves in one direction then reverses its course • One AC cycle is called a Hertz (Hz)

6. Electrosurgery • Electrocautery and electrosurgery do not mean the same thing (will hear terms used interchangeably) • ESU =’s cut and coag/ ECU =‘s coag ONLY • Electrocautery is using a heated wire to burn the patient’s tissue (eye cautery) • Uses DC current, no electricity enters the patient’s body

7. Electrosurgery • Two types ESU: Bipolar and Monopolar • Bipolar used for delicate procedures where there is moisture and a potential for nerve damage • Active and Dispersive electrodes are the tines of a two prong forceps • Monopolar is used for large surgical areas

8. Electrosurgery • Application or use of an electrical current to cut or coagulate tissue • Uses AC current • ESU Components: • Generator, optional foot pedal, cords, active electrode, and inactive dispersive electrode

9. Electrosurgery ESU Circuit: • ESU generator • Conductor cord • Active electrode (pencil) • Surgical site • Patient (is part of circuit with bipolar) • Dispersive electrode (grounding pad with monopolar other tine of forcep with bipolar) • Conductor cord • ESU Generator

10. Electrosurgery Hazards • Burns to the surgeon, surgeon assistants, STSR • Burns to the patient from poor grounding pad placement, pad becoming loose due to oils, hair, air pockets, or prep-solutions • Cautery plume: vaporized tissue contains carcinogens, BBP, and mutagens • Smoke evacuators should be used to counteract these hazards • Contain an air and charcoal filter

11. Basic Electrical Safety Guidelines • Remove jewelry when operating equipment • Secure long hair and loose clothing around power equipment • Wear PPE prn • Use equipment for intended purpose only • Never use equipment you are not trained to use • Inspect equipment prior to use • Disconnect power prior to maintenance on equipment • TURN OFF equipment power prior to unplugging or plugging in equipment • Never disconnect a plug by pulling on cord (pull on plug) • Hands should be DRY prior to handling equipment or cords/plugs • Keep equipment out of line of traffic to avoid injury to person or equipment • Tape cords down to floor if they are in traffic to avoid tripping

12. Electrical Safety Guidelines • Do not use electrical equipment when you’re touching metal or water • Unplug electrical equipment before cleaning, inspecting, repairing, or removing anything from them • Keep electrical equipment areas clean/free from flammable materials • Keep access panels and junction boxes clear • Know where fuse boxes and circuit breakers are • Make certain all electrical equipment is grounded • Do not use water on electrical fires • Report unsafe conditions/equipment to supervisor or biomedical/engineering department stat (Know policy of institution regarding damaged equipment)

13. Valleylab Generator • Features of the monopolar generator: • Cutting and coagulation settings available • Bipolar available on left of unit with separate settings • Settings average on 0-50 cut and 30-70 coag (surgeon preference) • Standard settings 30/30 • Constant increase requests by surgeon mean something is wrong • Troubleshooting problems: Tip must be checked, connections checked, if cannot resolve obtain a new bovie pencil first, change ground (circulator) change generator

14. Bovie scratch pad For non-teflon tips Teflon tip and bovie cleaner Bovie Pencil Bovie holster

16. Pediatric Grounding Pad Adult Grounding Pad

17. Non-disposable Tips Bayonet forcep McPherson’s bipolar forcep Disposable Ophthalmic Forceps Place in sharps container at end of case Bipolar Cautery Tips And disposable cord

18. EYE Cautery or High Temp Cautery Battery powered Used in Eye Surgery or Peripheral vascular surgery When a hole is needed in a synthetic Dacron graft These cannot be cut as the material will fray, so hole may be burned to seal the area

19. Monopolar Current travels from generator, to active electrode (cautery pencil), to patient (wound), to inactive or dispersive electrode (grounding pad), back to generator… All components must be present to avoid injury to patient and to utilize device Grounding pad placement must be on a fleshy, non-hairy, non-moist area where it is firmly stuck to skin Ground is placed by circulator Bipolar Current travels tip (active electrode) to patient to tip (dispersive electrode) and is powered by a generator No grounding pad is needed Utilized when a precise cauterization is needed in delicate procedures such as ophthalmic and neurosurgical where precision is key Can have a bipolar with an irrigating port, seen most frequently in neuroprocedures with a Bayonet style forcep (Malis Bipolar unit) Electrocautery Review

20. Monopolar Cautery • Various tips available: long, short, needle tip, teflon coated • Come in various colors depending on manufacturer • May be hand cautery or foot pedal controlled • Grounding pads must be appropriate size for patient (adult and pediatric available) • NEVER cut a grounding pad!

21. Tourniquets • Go to this site http://www.tourniquets.org and read: • tourniquet overview • use and care sections 2. Also read in Textbook St for the ST

22. Tourniquet Components • Esmark • Tourniquet Cuff (sterile disposable or clean non-disposable) • Pneumatic tourniquet machine

23. Safety Precautions • Tourniquet inflation times: • 1 hour for upper extremities • 1 ½ to 2 hours lower extremities • Times exceeding these recommendations put the patient at risk for nerve damage and or tissue ischemia (poor oxygenation/vascular compromise) which can cause tissue necrosis • Notify MD after tourniquet has been up for 1 hour. • Tourniquets may be deflated for 10 minutes and then re-inflated if necessary

24. Safety Precautions Continued • Tourniquet pressures: • Must not exceed 50-75 mm/Hg over patient’s systolic blood pressure for upper extremities • Must not exceed 100-150 mm/Hg over patient’s systolic blood pressure for lower extremities