Diathermy (Electrosurgery)

Last updated 08.03.13

 

 

Definition

-  Application of electric current to tissue to cut, coagulate, dessicate &/or fulgurate

 

Features

-  Common tool in surgery

-  High frequency electrical current between active & return electrodes

-  High freq to avoid nerve stimulation

-  Induces local tissue burning to an area determined by frequency, power & application

-  Enables precise cuts without significant blood loss

-  +/- Return electrode monitoring

-  +/- Isolated systems

-  Needle, spatula & ball shaped eletrode points

 

Diathermy

 

Machine

 

 

Types

-  Bipolar

-  Forceps (paired electrodes) create current when tines are in contact with tissues

-  Safer than monopolar

-  More expensive

-  Monopolar

-  Most common form

-  Pointed electrode used w pad (patient plate/dispersion pad) on patient

-  Often used to buzz vessles grasped w forceps

 

Monopolar

 

Modes

-  Cut

-  Low voltage, continuous

-  Primarly dissection

-  Electrode held slightly away from tissue

-   Generates greatest heat over shortest time

-  Coag

-  High voltage, non-continuous

-  Primarily haemostasis

-  Blend

-  Medium voltage, semi-continuous

 

Voltage

 

Cutting

 

 

Procedure

-  Select mode (cut, coag, blend)

-  If Monopolar

-  Patient plate to clean surface +/- conductive gel

-  Same side of body close to intended operative site

-  If metal in pt put plate between metal & site & on opposite side of body as metal

-  Common sites: outer thigh, abdo, back, scapula

-  Shave if needed

-  Application of electrode

-  Fulguration: held slightly away from tissues with coagulation

-  Dessication: hold electrode against tissue

-  Do not apply pressure

-  Scratch pad

-  Tissue on electrose reduces efficiency

-  Apply electrode to tissues

-  Some machines use foot pedal to activate

 

Complications

-  Burns

-  Surgeon: if make contact skin to instrument

-  Patient: poor contact w return electrode or contact w metal causing capacitance leakacke (alternite site burn)

-  Smoke: may conatin viral DNA, bacteria, carcinogens, irritants

 

Cautions

-  AICD, PPM

-  Orthopaedic plates..

 

 

 

References

 

 (incl Pics) www.valleylab.com/education/poes

RACS: ASSET course: Electrosurgery, 2013