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8/13/2019 Electro Surgical Units
1/21
Diathermy UnitsA Saudi Food & Drug
Administration Program
Senior Project Engineer
1Copyright 2007
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Diatherm Units
Electrosurgical Burns
Laparoscopic Accidents
n ur es to e ca ta
2Copyright 2007
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Some Basic Electrosurgery Facts
Used in about 80% of all surgical
Ver effective sur ical tool Cutting
Fulguration
Not well understood by clinicians
problem reporting databases
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Basic Princi les of Electrosur er
Current conducted through a complete circuit including
the generator, insulated cables, electrodes, and the patient
4Copyright 2007
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Mono olar Electrosur er
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ec rosurg ca
Unit
Tissue between
Current
Flowtips of forceps
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ec rosurgery a e y ea ures
Verifies that a return electrode is
Cannot detect if return electrode is
the patient
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Electrosurgery Safety Features
Return Electrode Contact Quality Monitor
continuity monitor
the dispersive electrode and patient
ECRI stron l recommends usinelectrosurgical units with RECQM
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Interrogation current flowse ween eac p a e o e
electrode and the patient.
one s e s par a ydetached from the patient,
an a arm w soun .
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Fires, Explosions Prepping Solutions, Surgical Drapes,
Bowel Gas
Oxygen-Enriched Atmosphere
Too Much/Too Little Power Delivered Organ Perforations
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Electrosurgical Accidents
Argon Beam Coagulators
Interference (EMI)
ESU as Source of EMI
Hand sensation
Alternate pathways
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Electrosurgical Injuries
Return Electrode Issues oor e ec ro e p acemen Lack of skin prep
omp e e or par a remova o re urnelectrodes
Edge effects
activation times
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ec rosurg ca n ur es
Insulation surrounding conductive shaft Breakdown
Repeated Sterilization
Cuts, Nicks, Abrasions
Capacitive Coupling
other instruments or tissues
Inadvertent activation!
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Active Electrode
Alternate Site Burns (Use a Holster!)
Laparoscopic Active Electrodes La arosco ic Cannula Burns
Failure to Use Activation Tone
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Inadvertent activation of the ESU due to
unintentional switch activation
User places active electrode on the patient or thesurg ca rape e ween n en e ac va ons
Safety holster not used
Insulation failure along shaft during,
burn to tissue inside mouth or to lip
tissue
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Poor Site Preparation Poor Application
technique
Non-uniformConductivity
Repositioning
Electrode
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Burns
Use of electrolytic (conductive) distention/irrigation
media during TURP Conductive solution may render electrosurgery less
effective
Lower surgical effect may lead user to increase
Conductive solution lowers impedance at active
electrode, elevating current Increased power and lower impedance increases
current through dispersive return electrode
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Laparoscopic Electrosurgery
Monopolar vs. Bipolar Current leakage though cannula
Insulation breaka e
Fire
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aparoscop c n ur es
Insulation failures Capacitive coupling
Device interference
Resulting in bowel perforations,
excess bleeding, damage to nontargettissue, etc.
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Heat, sparks, flaming gases
Rarel a device failure aknown complication
21Copyright 2007