1. Electrocautery

2. Terms Related to Electrocautery
ECU electrocautery unit
Cautery and Bovie are used interchangeably to describe the cautery pencil or active electrode
FYI: Bovie is the originator of electrocautery surgery, hence called a “Bovie” sometimes
Electro- (electrical/electricity)
Cauterize (stoppage of bleeding)

3. Electricity Terms: Current, Volts, OHM’s Law
Electrical Circuit
Hot Wire -wire that connects to the switch
Neutral Wire –serves as pathway for electrons to return to the energy source, completing the circuit
Ground Wire – separate wire that safely conveys any leaking electrons to the ground, preventing injury to the patient or personnel
Must have a ground wire to prevent electric shock
Generally in wires: red = hot wire, green = neutral wire, black = ground wire

4. Electricity Terms: Current, Volts, OHM’s Law
Wall Outlets
110V generally
Mobile X-Ray = 220V
Surgical outlet must have three prongs in surgery
First prong (positive)
Second prong (negative)
Third prong (ground)
Wall plates that are red are hooked up to the hospital generator and you will plug important electrical devices into those outlets that are vital to the patient and their surgery

5. Electricity Terms: Current, Volts, OHM’s Law
Electrical Systems
1. DC (direct current)
Flows in one direction from negative pole to positive pole
Flashlight is an example of a DC system
AC (alternating current)
Flow of current reverses periodically
One complete cycle occurs when the current moves in one direction then reverses its course
One AC cycle is called a Hertz (Hz)

6. Electrosurgery
Electrocautery and electrosurgery do not mean the same thing (will hear terms used interchangeably)
ESU =’s cut and coag/ ECU =‘s coag ONLY
Electrocautery is using a heated wire to burn the patient’s tissue (eye cautery)
Uses DC current, no electricity enters the patient’s body

7. Electrosurgery Two types ESU: Bipolar and Monopolar
Bipolar used for delicate procedures where there is moisture and a potential for nerve damage
Active and Dispersive electrodes are the tines of a two prong forceps
Monopolar is used for large surgical areas

8. Electrosurgery
Application or use of an electrical current to cut or coagulate tissue
Uses AC current
ESU Components:
Generator, optional foot pedal, cords, active electrode, and inactive dispersive electrode

9. Electrosurgery ESU Circuit: ESU generator Conductor cord
Active electrode (pencil)
Surgical site
Patient (is part of circuit with bipolar)
Dispersive electrode (grounding pad with monopolar other tine of forcep with bipolar)
ESU Generator

10. Electrosurgery Hazards
Burns to the surgeon, surgeon assistants, STSR
Burns to the patient from poor grounding pad placement, pad becoming loose due to oils, hair, air pockets, or prep-solutions
Cautery plume: vaporized tissue contains carcinogens, BBP, and mutagens
Smoke evacuators should be used to counteract these hazards
Contain an air and charcoal filter
Charcoal absorbs odor and hydrocarbons
Occupational hazard and patient hazard

11. Basic Electrical Safety Guidelines
Remove jewelry when operating equipment
Secure long hair and loose clothing around power equipment
Wear PPE prn
Use equipment for intended purpose only
Never use equipment you are not trained to use
Inspect equipment prior to use
Disconnect power prior to maintenance on equipment
TURN OFF equipment power prior to unplugging or plugging in equipment
Never disconnect a plug by pulling on cord (pull on plug)
Hands should be DRY prior to handling equipment or cords/plugs
Keep equipment out of line of traffic to avoid injury to person or equipment
Tape cords down to floor if they are in traffic to avoid tripping

12. Electrical Safety Guidelines
Do not use electrical equipment when you’re touching metal or water
Unplug electrical equipment before cleaning, inspecting, repairing, or removing anything from them
Keep electrical equipment areas clean/free from flammable materials
Keep access panels and junction boxes clear
Know where fuse boxes and circuit breakers are
Make certain all electrical equipment is grounded
Do not use water on electrical fires
Report unsafe conditions/equipment to supervisor or biomedical/engineering department stat (Know policy of institution regarding damaged equipment)
Examples frayed cords, bent plugs, broken switches or outlet covers, smoking or sparking of equipemtn, extension cords in permanent use (should have equipment with proper cord length as JCAH do not recommend use of drop cords-fines involved if caught)ds

13. Valleylab Generator Features of the monopolar generator:
Cutting and coagulation settings available
Bipolar available on left of unit with separate settings
Settings average on 0-50 cut and coag (surgeon preference)
Standard settings 30/30
Constant increase requests by surgeon mean something is wrong
Troubleshooting problems: Tip must be checked, connections checked, if cannot resolve obtain a new bovie pencil first, change ground (circulator) change generator

14. Bovie scratch pad
For non-teflon tips
Teflon tip and bovie cleaner
Bovie Pencil
Bovie holster

16. Pediatric Grounding Pad
Adult Grounding Pad

17. Disposable Ophthalmic Forceps Place in sharps container at end of case
Non-disposable
Tips
Bayonet forcep
McPherson’s bipolar forcep
Disposable Ophthalmic Forceps
Place in sharps container at end of case
Bipolar Cautery Tips
And
disposable cord

18. EYE Cautery or High Temp Cautery Battery powered Used in Eye Surgery
Peripheral vascular surgery
When a hole is needed in a synthetic
Dacron graft
These cannot be cut as the material
will fray, so hole may be burned to seal
the area

19. Electrocautery Review
Monopolar
Current travels from generator, to active electrode (cautery pencil), to patient (wound), to inactive or dispersive electrode (grounding pad), back to generator…
All components must be present to avoid injury to patient and to utilize device
Grounding pad placement must be on a fleshy, non-hairy, non-moist area where it is firmly stuck to skin
Ground is placed by circulator
Bipolar
Current travels tip (active electrode) to patient to tip (dispersive electrode) and is powered by a generator
No grounding pad is needed
Utilized when a precise cauterization is needed in delicate procedures such as ophthalmic and neurosurgical where precision is key
Can have a bipolar with an irrigating port, seen most frequently in neuro procedures with a Bayonet style forcep (Malis Bipolar unit)

20. Monopolar Cautery
Various tips available: long, short, needle tip, teflon coated
Come in various colors depending on manufacturer
May be hand cautery or foot pedal controlled
Grounding pads must be appropriate size for patient (adult and pediatric available)
NEVER cut a grounding pad!

21. Tourniquets Go to this site http://www.tourniquets.org and read:
tourniquet overview
use and care sections
2. Also read in Textbook St for the ST

22. Tourniquet Components
Esmark
Tourniquet Cuff (sterile disposable or clean non-disposable)
Pneumatic tourniquet machine

23. Safety Precautions Tourniquet inflation times:
1 hour for upper extremities
1 ½ to 2 hours lower extremities
Times exceeding these recommendations put the patient at risk for nerve damage and or tissue ischemia (poor oxygenation/vascular compromise) which can cause tissue necrosis
Notify MD after tourniquet has been up for 1 hour.
Tourniquets may be deflated for 10 minutes and then re-inflated if necessary

24. Safety Precautions Continued
Tourniquet pressures:
Must not exceed mm/Hg over patient’s systolic blood pressure for upper extremities
Must not exceed mm/Hg over patient’s systolic blood pressure for lower extremities