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

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

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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