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Electrosurgical Safety (2.11)

Electrosurgical Safety (2.11) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Clinical

2.11

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1978
ORIGINAL
 REVISION

AUGUST 2017
PAGE 1
OF 4
POLICY #

2.11
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
ELECTROSURGICAL SAFETY



I. PURPOSE
To provide guidance for perioperative staff regarding safe use and maintenance of electrosurgical
units (ESUs) as well as surgical smoke safety precautions.

II. POLICY
A. Electrosurgical units (ESUs) will be inspected by biomedical personnel every six months as
recommended by manufacturer and labeled with the last date of inspection. The inspection includes
reviewing the internal/external components for damage, confirm generator output, function test, check
leakage current, and ground resistance.
B. Prior to patient use, all new “types” of electrosurgery dispersive pads should be evaluated and
approved by Clinical Engineering.
C. The single-use dispersive electrode will remain intact as packaged and not be cut to reduce its size.
D. The active electrode (pencil or forceps) will be placed in a safety holster when not in use.
E. The electrosurgical unit ID number will be documented in the patient clinical record.
F. The single-use dispersive electrode pad will be placed by an RN or MD or under their supervision.
G. Use disposable accessory cords whenever possible.

III. PROCEDURE
A. Familiarize yourself with the electrosurgical unit.
1. Review proper settings for specific ESUs.
2. Locate the volume control.
3. Assure an acceptable return electrode pad is available.
B. Position equipment to prevent stress to cords or hazard to personnel.
1. Cords should be free of loops or twists and should not be wrapped around the handle of the ESU
electrode pencil. The unit should be placed near the sterile field to avoid stress on the end or
blockage of traffic.
C. Operate the ESU at the lowest effective power setting.
1. Output settings are determined by the surgeon.
2. Do not continue to increase power settings if you are not observing increased results.
3. Confirm adequate placement of the return electrode pad.
4. Check all cable connections.
5. Replace machine or electrode pencils as one of the trouble shooting steps.
D. Placement of liquids on top of the ESU must be avoided.
1. Protect the unit from spills that may leak into the ESU and cause damage.
E. Eliminate patient contact with any metal device. If a reusable return electrode (Megadyne) is used
patients are safe from metal contact burns. If you are using a single-use dispersive electrode
monitoring pad (sticky pad) rings or jewelry from body piercing should be removed if possible.
1. Metal such as the operating room table may offer an alternate return path for the electrical

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1978
ORIGINAL
 REVISION

AUGUST 2017
PAGE 2
OF 4
POLICY #

2.11
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
ELECTROSURGICAL SAFETY



current.
F. Check the integrity of the single-use dispersive electrode pad package or reusable return electrode gel.
1. The outer wrapper of the pad is removed by the person placing the pad. Reusable return electrode
pads are enclosed in a pressure reduction gel covering which can be damaged if mishandled.
G. Use the appropriate sized dispersive electrode pad.
1. The entire conductive surface of a single-use dispersive electrode pad must be in direct contact
with the patient. Pad choice should be consistent with package labeling and recommendations
related to patient size, weight, or age range.
2. Megadyne Reusable Electrode pad will be used according to manufacturers directions; Adult
Megadyne – 25 lbs and over, Pediatric Universal Megadyne – children 0.8 lbs and over.
H. For single-use dispersive electrode pads, select a site that is muscular, clean, dry and as close as
possible to the operative site (i.e. thigh, buttocks, large arms or calves, and backs).
1. Avoid bony prominences, skin folds, scar tissue, areas of excessive adipose tissue or hair, limb
with restricted blood flow, or directly over metal implants.
2. Avoid placing the single-use dispersive electrode pad over tattoos, as many tattoos contain
metallic dyes.
3. Single-use dispersive electrode pad(s) should be placed on patient after final positioning for the
surgical procedure to prevent buckling of electrode.
I. Reusable Electrode pad (Megadyne) can be placed on OR table as a grounding device for all patients
with the exception of patients being positioned in steep Trendelenburg, and patients with a BMI of
more than 55.
J. Alternate sites for single-use dispersive electrode pad placement require a discussion with the surgeon
and documentation of the verbal communication in the patients clinical record.
1. Document accordingly.
K. Do not overlap sections of the single-use dispersive electrode pads.
L. When using flammable prep solution (e.g., ChloraPrep, alcohol, etc.), allow the prepped area to
completely dry (at least 3 minutes) before activating the electrode pencil.
M. Avoid pooling of prep solutions.
1. Solutions may be ignited by the electrical current.
2. Solutions may loosen the single-use dispersive electrode pad from complete contact with the
patient’s skin.
N. Check contact and adherence of the dispersive electrode pad(s) each time the patient is repositioned.
O. Inspect the active electrode for defects prior to use.
1. Look for insulation cracks or loosening at the terminals.
2. Before surgery, verify that the electrode is fully inserted into the hand piece. No exposed metal
should be visible near the hand piece orifice.
P. Keep the tip of the active electrode clean.
1. Assure that the tip is clean if there is an unusual request for increased power.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1978
ORIGINAL
 REVISION

AUGUST 2017
PAGE 3
OF 4
POLICY #

2.11
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
ELECTROSURGICAL SAFETY



Q. When a patient has a Pacemaker or Implantable Cardioverter Defibrillator device refer to the Heart
and Vascular Care Departmental Policy: HVC Management of Pacemaker or Implantable
Cardioverter Defibrillator (ICD) Devices in a Procedural Setting and Appendix E.
1. Keep the current path (electrode tip to ground plate) as far away as possible from the pulse
generator. Do not perform within 6 inches of the pulse generator.
2. Set the electrocautery at the lowest possible clinically effective setting. Use bipolar if possible.
3. Do not apply electrocautery directly on or over the pulse generator.
4. Electrocautery on or near the lead tip may cause burning of the lead-tissue interface.
5. Use short bursts of cautery.
6. Place single-use dispersive electrode pad on opposite side leg.
7. If the pulse generator is continually inhibited by frequent bursts of electrocautery, a magnet may be
placed on the pulse generator, which would result in asynchronous pacing (pacemakers only). This
should only be done if the pacemaker has been previously determined to be of the make,
model, and programming set that can produce this result. This should be discussed with the
device RN during regular business hours or with either the EP provider or Cardiology
Fellow prior to procedure.
R. Cochlear Implant patients, use bipolar technology only.
S. Guidelines to reduce intraoperative staff exposure to surgical smoke (plume).
1. A smoke evacuation system should be used (Neptune Smoke Evacuation System, Hi-Flow Suction
Canisters, laparoscopic filters).
2. Place suction tubing within 2-inches of the site of surgical smoke generation or use a smoke
evacuation pencil if appropriate for the surgery.
3. Wear personal protective equipment (PPE) correctly. Make sure mask strings are tied appropriately
to create a tight fit around the face; wear a fit-tested N95 respirator for any higher-risk, aerosol-
generating procedure and for any procedure performed on a patient suspected or known to be on
airborne precautions.
4. Dispose of Neptune Smoke Evacuation System filters when Neptune display indicates replacement
and or/other devices used for smoke evacuation (e.g. suction canisters, or laparoscopic filter.)
a. According to the Stryker Neptune 2 Instructions For Use the smoke filter recommended
life cycle is 80 hours. Reset the timer whenever the filter is changed.
T. Documentation of the following information in the patient clinical record:
1. ESU Type and ESU unit ID.
2. Mode (Monopolar or Bipolar).
3. Single-use dispersive electrode pad location and laterality and/or use of Megadyne
reusable electrode pad.
4. Settings or range used (cut and coagulation).
5. Applied by whom.
6. Also note any abnormal skin condition or lesions pre-operatively and complete a post-operative

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1978
ORIGINAL
 REVISION

AUGUST 2017
PAGE 4
OF 4
POLICY #

2.11
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
ELECTROSURGICAL SAFETY



assessment of the ESU pad site.
7. If any problems are discovered during or after the procedure, save all ESU components and their
packages and take the ESU out of service.
U. If patient injury, follow the UW Health Policy #12.40 Reporting of Device-Related Adverse
Events & Other Product Problems and the UW Health Policy # 1.3.2 Reporting Unexpected
Events and Determination of Sentinel Event Status


IV. REFERENCES

A. Access data.fda.gov – Coviden K102913 4/28/2011
B. MedSun News 12/04
C. AORN Guidelines for Perioperative Practice 2017, pages 129-155, 477-505, 631
D. Heart and Vascular Care Clinic, Management of Pacemaker or Implantable Cardioverter Defibrillator
(ICD) Device in a Procedural Setting.
E. Improperly Seated Electrosurgical Active Electrodes Can Burn Patients, ECRI 2007
F. UW Health Policy 6.01 Fire Response Guidelines – Intraoperative Areas and ESU Fire Prevention
Interventions

REVIEWED BY:

Surgical Services Policy and Procedure Committee
Jason Pearson, Surgical Material Coordinator, 2/2017
Ashley J. Rusch, BSN, RN, CNOR, Nursing Education Coordinator 2/2017
Shannon Schauff, RN, Device Clinic Coordinator 6//2017

SIGNED BY:

Anne Mork, MHCDS, MS, RN
Director, Surgical Services Department