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Operation for Electrical or Thermal Cautery - Mohs Surgery Clinic East and West (12.31)

Operation for Electrical or Thermal Cautery - Mohs Surgery Clinic East and West (12.31) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Clinic Specific

12.31

12.31 Operation for Electrical or Thermal Cautery ‐ Mohs Surgery Clinic East and West  
Category:  UWHC Departmental Policy   
Policy Number:  12.31    
Effective Date:  September 25, 2013   
Version:  Revision    
Manual:  Ambulatory    
Section:  Clinic Specific (Ambulatory)   
 
 
I. PURPOSE

To establish a process for Physicians and Registered Nurses (RNs) to use electrical or thermal cautery to achieve
hemostasis after a procedure.

II. DEFINITION

A cautery unit is a mechanical device used to occlude open blood vessels by use of electrical current or heat.

III. POLICY
A. Orientation to use and precautions must occur prior to anyone using electrical or thermal
cautery. Nursing staff will assist the physician and monitor the patient when the cautery is used. Nursing
staff is responsible for the set up, take down and disinfecting of equipment.
B. Orientation of Physicians, Fellows, RNs, and Visiting Residents - The Staff Physician will provide orientation
to Fellows, Residents and RNs on hyfrecating technique within the clinic setting. Before an RN uses
cautery independently, RN will complete the Training and Competency Written Test (see attached) and a
copy will be provided to Nursing Education.
IV. PROCEDURE
A. Cautery type will be based on Physician preference and patient history obtained by nursing staff. There
are three cautery units used in Mohs Surgery Clinic: Delasco, ConMed, and Geiger. See table for when to
use.
Device Type Pacemaker Defibrillator
Brain
Stimulator
Grounding Pad
Delasco Monopolar No No No No
Bipolar Yes No Yes No
ConMed Monopolar No No No Yes
Bipolar Yes No Yes No
Geiger
(heat)
Yes Yes Yes No
B. Appropriate personal protection equipment to be used for all, per Administrative Policy #12.44 -Personal
Protective Equipment.
C. If bleeding excessive, difficult to control, or is in a vulnerable area such as eyelids or genital areas, the
Physician will be notified and may be requested to assist with or continue the procedure.

D. Document cautery used during the procedure in the patient's electronic medical record.
E. Delasco
1. Equipment
a. Delasco cautery unit
b. Delasco tip and cautery handle
c. Bipolar handle, forceps and foot plate for patient with pacemaker
d. Wall vacuum suction unit
2. Settings for Delasco unit – Normal hyfrecation control setting is 8-12. Increase in increments of
1; not to exceed setting of 18, unless directed by Physician.
3. Procedure
a. Inform patient of cautery use.
b. Assess patient and surroundings for potential hazards.
i. Note: No grounding of patient is necessary with the Delasco monopolar cautery
unit, but check and make sure that patient is not touching any metal such as on
the armrests of chairs.
ii. Caution: Cautery should not be used in the presence of oxygen. Patients with
pacemakers need Physician assessment prior to use. The bipolar attachment
will be used with patients with a pacemaker.
iii. Note: Do not use the Delasco unit on patients with a defibrillator.
c. Place tip into top of handle.
d. Turn Delasco unit on and to a setting of 8-12. Check that power light is on and a low
“buzz” is heard when holding the “ON” switch of the handle.
e. Using a cotton tipped applicator or gauze, roll back and forth over the bleeding wound,
cauterizing as you isolate the areas of bleeding using a steady hand and pinpoint touch.
f. Active bleeders are cauterized, followed by the skin edges. If bleeding is minimal, a
topical hemostatic agent may be used instead of cautery.
g. If wound is large, or excessive cautery is required, you may rinse the area with sterile
saline to remove charred debris.
h. After use, tip is removed and disposed of in red sharps container. Wipe unit and handle
with hospital-approved disinfectant.
F. ConMed
1. Equipment
a. ConMed Sabre 180 cautery unit
b. ConMed Surefit Dual Dispersive Electrode (Ref 410-2000)
c. ConMed Hand Controlled Blade Electrode (Ref 131309)
d. ConMed Bipolar Cable (Ref 60-5102-002)
e. ConMed Bipolar forcep (various sizes-autoclavable)
f. Portable suction unit and tubing (Ref ESU-3000/S)
2. Settings for ConMed unit - Monopolar use control setting is 18; or as directed by
Physician. Setting for ConMed bipolar use is established by Physician; Portable suction setting is
1 to 6 (with lowest setting that controls smoke/plume preferred).
3. Procedure
a. Inform patient of cautery use.
b. If using monopolar cautery, apply dual dispersion electrode (grounding pad) on the
patient’s trunk, arm or thigh on skin that has as little hair as possible. Clipping the hair
may be needed to ensure optimal contact. No grounding pad is used for bipolar cautery.
c. Plug ConMed pencil handpiece cord and dispersion/grounding pad cord into appropriate
outlets on the ConMed Sabre unit.
d. Turn the ConMed to ‘ON’. After the unit gives audible signal, press ‘MODE’.
e. The setting for monopolar cautery should be at 18, unless the Physician requests a
change. The bipolar setting will be determined by the Physician.
f. The suction unit should be set up and tubing attached to the ConMed pencil
handpiece. Set Stackhouse unit for footswitch operation and adjust suction to desired
setting to control smoke while cauterizing.
g. Using a cotton tipped applicator or gauze pad, roll back and forth over the bleeding
wound, cauterizing as you isolate bleeding points. Active bleeding points in the wound
bed are cauterized first, followed by those near the skin edges. Use care to avoid
damage to skin and underlying tissue by over cauterizing. Wall suction may be used with
continuous ‘ON’ setting.
h. After use, the handpiece tip should be carefully removed and disposed of in red sharps
container. The dispersion/grounding pad can be disposed of in trash receptacle.
i. Cautery unit, handle and suction unit should be wiped off with hospital-approved
disinfectant.
G. Geiger
1. Equipment
a. Geiger thermal cautery unit

b. Geiger cautery hand piece
c. Geiger general purpose cautery electrodes
d. Smoke plume evacuator
e. Wall suction unit
2. Settings for Geiger unit - The settings for heat cautery on this unit range from 1-10. The setting
is determined by location of bleeding, reason for use, etc. The setting for an eyelid lesion will be
the lowest possible to achieve hemostasis.
3. Procedure
a. Inform patient of cautery use.
b. Assess patient and surroundings for potential hazards. Materials such as cotton tipped
applicators and gauze should not come into contact with the cautery electrodes when in
use, as they could spark or ignite.
c. Place tip into top of handle.
d. When suction is available, turn to "CONTINUOUS ON" position.
e. Turn Geiger unit on to 1-10, appropriate to the location and indication for use.
f. Using a cotton tipped applicator or gauze, roll back and forth over the bleeding wound,
cauterizing as you isolate the areas of bleeding using a sweeping motion.
g. Active bleeders are cauterized, followed by the skin edges. If bleeding is minimal, a
topical hemostatic agent may be used instead of cautery.
h. If wound is large, or excessive cautery is required, you may rinse the area with sterile
saline to remove charred debris.
i. After use, turn the unit off and remove tip. If disposable tip used, place in red sharps
container; if reusable tip used, place in dirty instrument tub for reprocessing. Wipe unit
and handle with hospital-approved disinfectant.

V. REFERENCES

Administrative Policy 12.44 - Personal Protective Equipment
Administrative Policy 13.20 - Cleaning, Disinfection and Sterilization of Patient Care Instruments and Equipment
Administrative Policy 13.09 - Sharps Disposal

VI. WRITTEN BY

Mohs Surgery Clinic West Nursing Staff

VII. REVIEWED AND APPROVED BY

Clinic Manager, Mohs Surgery Clinic
Ambulatory Policy and Procedure Committee
Clinics Administration

SIGNED BY

Deborah D. Tinker, MSN RN CENP, Director, Ambulatory Nursing