SAFE USE OF DIATHERMY

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SAFE USE OF DIATHERMY

• RACHEAL AFOLABI, RN, RM, H. Dip. PERI-OPERATIVE
  NURSING, H.Dip. HEALTH SYSTEM MANAGEMENT

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Diathermy is one of the most commonly used tool
in the operating theatre
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DEFINITION

• Diathermy is the generation of heat in body
  tissues by means of radiofrequency energy
  (passage of an electric current through the
  tissues). The energy is used to cut tissues, seal
  blood vessels and destroy unwanted cells by the
  deliberate application of intense heat.

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Two basic patient circuits are used

• Monopolar
• Bipolar

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MONOPOLAR

• During monopolar diathermy the patient forms part
  of the electrical circuit, only one side of the
  generator output is connected to the active
  electrode. The other side is connected to a large
  patient return plate. The plate provides a safe
  path for the current to pass back to the
  diathermy.

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Completed Circuit
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BIPOLAR

• During bipolar diathermy the current flows
  between the tips of the forceps, one tip acting
  as an active electrode and the other as a return.
  The patients tissue acts as the conducting
  medium, through which the current will flow. One
  advantage with this type is that production of
  the cutting current is virtually impossible. The
  field of coagulation is limited to the contact
  area

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BIPOLAR (Cont.)

• the surrounding tissues are not damaged. There is
  no patient plate attached.

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EFFECTS OF SURGICAL DIATHERMY

• CUTTING
• COAGULATION/DESICCATION
• FULGURATION

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PATIENT PLATE/RETURN ELECTRODE

• A minimum conductive area of 10 sq inches is
  recommended. Plate must be kept in secure contact
  with the patients body surface.

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SETTINGS ON ELECTRO-SURGICAL UNIT

• Blends setting
• Autocut
• Autocoag
• Users must ensure that they are familiar with all
  settings and their functions

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TYPES OF PATIENT PLATES

• REUSABLE
• DISPOSABLE

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DISPOSABLE PLATES

• CONDUCTIVE ADHESIVE PLATES
• Generally thin, lightweight flexible
• Conductive adhesive which works like gel
• Continuous adhesive border

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ROUTINE DAILY THEATRE CHECK

• This must include checking the electro-surgical
  unit to ensure that
• - All cables electrodes insulation are intact
• - Adequate supply of patient plates
• Functioning alarm systems
• Connections are all fitting securely
• Foot pedals are all present working

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THINK SAFETY!!!
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POINTS TO REMEMBER IN PROPER PATIENT PLATE USE

• Ensure regular, planned preventative maintenance
  checks
• Any faulty equipment must be removed immediately
• Plates are single use
• Avoid placement near scars, implant sites or ECG
  electrodes
• A muscular well vascularised area is most suitable

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POINTS (Cont.)

• Site must be clean, dry shaved
• Protect skin integrity by ensuring pt is not
  resting on dispersive plate clamp
• The diathermy setting is determined by the
  surgeon
• Be familiar with normal power settings
• Do not allow fluid to pool at dispersive site
• Check pt contact connection before commencing

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POINTS (Cont.)

• Ensure pt is not in contact with any metal
• Place active electrode in a quiver when not in
  use
• Only aqueous fluids should be used for irrigation
• On completion of procedure, remove the plate
  carefully inspect the skin
• Document use of diathermy in pts record

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SUGGESTED SITES FOR PLATE PLACEMENT

• CALF
• UPPER ARM
• ABDOMEN
• MID BACK
• BUTTOCKS
• ANTERIOR POSTERIOR THIGH

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THINK SAFETY!!!
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Pad Site Burn
AORN Journal, March 1991
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HAZARDS OF ELECTRO-SURGERY

• ACCIDENTAL BURNS
• SURGICAL SMOKE
• MINIMAL ACCESS SURGERY
• ENDOSCOPIC SURGERY

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CAUSES OF THERMOELECTRIC BURNS

• Poor patient plate contact
• Hair at the site of return electrode plate
• Break in the wire connecting the plate to the
  electro-surgical unit
• Detached return cable
• Ignition of flammable material on pts skin
• High voltage electrocution of the pt
• Abnormally high power setting

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References

• 3M Health Care (2000) Safety in Surgical
  Diathermy 3M Health Care Ltd., England
• Wicker, P. (2000) Electrosurgery in perioperative
  practice. British Journal of Perioperative
  Nursing. Vol 10 (4).

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Cont..

• Electrosurgical Safety Guide, ConMed Corporation,
  USA.

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THANK YOU FOR LISTENING