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Electrosurgical safety

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Chloe Templeton

on 30 April 2015

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Transcript of Electrosurgical safety

• 2011 article
• Objective: to define electrosurgery; the physics of electrosurgery; describe the two wave forms of current – cutting and coagulation as well as blended current; describe monpolar, bipolar and argon beam electrosurgery; describe the complications of electrosurgery

• Electrosurgery Waveforms










• “Surgical smoke is produced by the action of diathermy on tissue. Chemical analysis has shown that 5% of it is made up of potentially harmful chemicals and cellular debris. This has raised the concern about the hazard of surgical smoke to staff and patients. In vitro studies analysing the chemical composition of surgical smoke have identified as many as 80 chemicals, including hydrocarbons, nitriles, fatty acids and phenols. To minimize the associated health hazards, specially designed smoke evacuation systems should be used where available and surgical filtration masks donned for all surgical procedures,” (Gallagher, 2011, p. 72)


Karina Tan
Electrosurgical Equipment
HOW did ACORN arrive at these standards?

ACORN is concerned with the safe use of
electrosurgical equipment in the
perioperative environment.
The ACORN Standards review process is managed by the Standards Editor and the Standards Committee Chair.
ACORN standards are reviewed by teams comprising of clinicians, researchers, managers, educators, academics, and industry representatives across a wide scope of practice settings.
ACORN also works closely with the Joanna Briggs Institute, the Standards review team leaders and reviewers, and the publisher.
The ACORN Board examined and incorporated the AS/NZS 2500:2004 Guide to the Safe Use of Electricity in Patient Care standards.
Evidence-based literature and ongoing research studies are reviewed and if relevant, are included into the formation of the ACORN standards.
ACORN drafts are then reviewed stringently by the Standards Editor, the Standards Committee and the ACORN Board. Clearance is then given by the Legal Team.

To the Patient
"An education program shall be established for all personnel involved in the application and use of electrosurgical equipment within the perioperative setting, with further education planned for all newly introduced and implemented electrosurgical devices"
Training should be given to all relevant personnel, ie. Surgeons, 1st Assistants, Scrub / Instrument RN’s and Theatre Technicians.
Standard Statement 2:
All personnel shall take proactive precautionary measures to reduce injury risks and promote patient safety associated with the safe use of electrosurgical equipment.
ACORN Recommends:
Standard Statement One:
Check :

Connectors and cables are intact with no damage, no kinks, and are not coiled
Footswitch is protected with an impervious cover
Connections to power source are secure
No fluids placed on the unit
Alarms are tested and audible
Lowest required power settings are chosen

Standard Statement 3
Electrosurgical Equipment shall be routinely inspected and checked before use, and undergo planned preventative maintenance.


Standard Statement Four
The Standards are designed to assist Health Service Organisations to deliver safe and high quality care.
Standard One:
Governance for Safety and Quality in Health Service Organisations


STANDARD THREE: INFECTION PREVENTION:
Promoting collaboration with occupational health and safety programs to decrease the risk of infection or injury to healthcare workers.
Describes the quality framework required for health service organisations to implement safe systems.
Adopting processes to support the early identification, early intervention and appropriate management of patients at increased risk of harm.
Implementing a system that determines and regularly reviews the roles, responsibilities, accountabilities and scope of practice for the clinical workforce.
Ensuring that Health Care Organisations are complying with regulatory bodies such as Worksafe and the Occupational Health and Safety Act 2004
Some of these policies and procedures include:
Identifying safety and quality risks
Collecting and reviewing performance data
Implementing prevention strategies based on data analysis
Analysing reported incidents
Implementing performance management procedures
Ensuring compliance with legislative requirements and relevant industry standards
Communicating with and informing the clinical and non‑clinical workforce


Reprocessing reusable medical equipment, instruments and devices in accordance with relevant national or international standards and manufacturers’ instructions as well as checking the integrity and supply of sterile stock.
Ensuring disposable/single use only diathermy equipment is stored and used appropriately.
Electrosurgical equipment (e.g. Diathermy Machine) is cleaned in between cases
Conductive pads are changed for each patient.

Staff
Facility

Use of electrosurgical equipment shall be documented.
Circulating RN should document :
type of electrosurgical equipment used
site and type of the dispersive electrode
patient’s skin integrity prior to and following removal of the dispersive electrode
any other health care facility specific requirements

Hospital Policy
Hospital A, B & C policy overview:
These Hospitals polices all generally recommend:
- The type of electrosurgical equipment
- Safety considerations to be followed when electrosurgical equipment is in use.
- Equipment is only to be used by authorized personnel
- The detailed steps, procedures and actions for the equipment in conjunction
with safety measures to be taken in order to protect the patient.
They also recommend that electrosurgical equipment is potentially
dangerous, and therefore it is very important that all personnel completely
understand the function and operation of the equipment.
Comparisons of Hospital Policies

- Some Hospitals had more extensive policies than others.
- Covered majority the safety and risk aspects of electrosurgical equipment,
equipment required, definitions and references the ACORN standard.
-Some Hospital policies didn’t describe:
- Education required
- The documentation required with use of Electrosurgery equipment
- Specific hospital methods of use for the equipment.
Hospital D Policy
Purpose :
To provide guidance to implement and evaluate practice associated with the
safe use of electrosurgical equipment in the perioperative environment
(ACORN, 2014).
Policy:
Provides information on the principles of safety in electrosurgery
Gives valid recommendations on the correct use of electrosurgical equipment in the perioperative environment (ACORN, 2014).
Hospital D doesn’t occupy a policy or protocol for Electrosurgical Equipment
- Uses the ACORN Electrosurgical Equipment standard instead.
The ACORN standards and their four Standard statements
Standard statement 1: An education program for all personnel, with
further planned education for new and implemented devices.
- Standard Statement 2: Reduce risk and promote patient safety
associated with the use of electrosurgical equipment
- Standard statement 3: Equipment should be routinely inspected and
checked before use and have planned maintenance
- Standard statement 4: Use of electrosurgical equipment shall be
documented. (ACORN, 2014)
The National Safety and Quality Health Service Standards (NSQHS):
-Standard 1: Governance for safety and quality in health service
organizations.
A
ssociation of peri
O
perative
R
oom
N
urses
AORN is a non-profit membership association based in the USA that represents more than 160,000 perioperative nurses. AORN’s vision is to be the indispensable resource for evidence-based practice and education that establishes the standards of excellence in the delivery of perioperative nursing care.
AORN recommends that the Electrosurgical Unit (ESU) and accessories should be used according to manufacturers’ written instructions.
1. Instructions for ESU use, warranties, and a manual for maintenance and inspections should be obtained from the manufacturer and be readily available to users.
2. Each type of ESU has specific manufacturer’s written operating instructions to be followed for safe operation of the unit. A brief set of clearly readable operating instructions should be readily accessible with each system.
3. Accessories should be used, handled, cleaned, and processed according to manufacturers’ instructions.
(AORN Standards and Recommended Practices for Peri-operative Nursing, 2005, p. 618)

Assess Pad Site Location


CHOOSE:

Well vascularized muscle mass
AVOID:

Vascular insufficiency
Irregular Body Contours
Bony Prominences
CONSIDER:
Incision site and prep area
Patient position
Other equipment on patient

(Covidien 2011, p.10)

Presenters
Critically appraise the standards and
research associated with the use of
electrosurgical equipment
Karina Tan
Chloe Templeton
Jess Taranto
Natasha Rich
What is electrosurgery and how is it used?
ESU’s are used for surgical cutting or to control bleeding by causing coagulation (hemostasis) at the surgical site. They deliver high-frequency electrical currents and voltages through an active electrode, causing desiccation, vaporization, or charring of the target tissue.
common Types of Electrosurgery
Bipolar
Monopolar
Active output and patient return functions are both at the site of surgery
Current Path is confined to tissue grasped between the forceps

The active electrode is in the wound
The patient return electrode is attached somewhere else on the patient
Must have: generator, active electrode, patient and patient return electrode
The electrode is in direct contact with the tissue and the cells dry out and form coagulum rather than vapourise and explode

Cutting:
The electrode is held slightly away from the tissue and divides the tissue with electric sparks that focus intense heat at the surgical site and cause the cells to vaporise
Coagulates and chars the tissue over a wide area at the same time
Fulguration
Desiccation
Electrosurgical tissue effects
Brace, M. D. et al., 2014. ‘The air that we breathe’: assessment of laser and electrosurgical dissection devices on operating theatre air quality. Journal of Otolaryngology - Head & Neck Surgery, 43(39).

· 2014 article
· Objective: to measure changes in air quality during surgery.
· Where: Victoria General Hospital in Halifax, Nova Scotia, Canada
· How: 3 monitoring devices were used. One in the operating theatre. One in the hallway outside of theatre and one approximately 900m away from theatre as a control.
· Cases: Air quality measurements were conducted for 146 surgical cases over 57 days during a study period of 80 days. A total of 16 cases had no record of electrosurgical device used.
· Results:
¨ Operating room (OR) air is consistently cooler with decreased humidity, which may cause airway irritation.
¨ OR air filtering and exchange systems do exist. Smoke plume evacuators are also recommended, unfortunately, these devices are often cumbersome to use or bulky to handle and often are not employed by surgeons.
¨ Surgical masks afford an additional level of protection from aerosolized contents of surgical smoke.
¨ The use of cautery appears to be associated with the liberation of significantly increased levels of UFPs (ultrafine particles) compared to laser and cold dissection cases. This is the most important finding of this study. UFP’s have been linked to respiratory disease with evidence demonstrating increased exacerbations of asthma corresponding to increased environmental UFP counts. The long-term effect of exposure to these particles is unknown. For surgical cases utilizing cautery devices, the standard surgical masks will not filter any of the UFPs.
¨ The level of UFPs measured in the OR was significantly lower than that measured in the outside air. This observation was true for all measured particles. The OR environment sampled in this study is equipped with a filtered air exchange system that provides 18-20 air exchanges per hour. This obviously plays an important role in not only filtering the products of surgery out of the OR, but in filtering the air supplied to the OR as well. Overall, the air quality in terms of particle counts was better in the OR than the outside air.
¨ Further research is required.
karina tan
Karina tan
natasha rich
Gallagher, K., Dhinsa, B. & Miles, J., 2011. Electrosurgery. Surgery (Oxford), 29(2), pp. 70-72.
Harmonic Scalpel
Ligasure
It uses ultrasound technology to cut tissues while simultaneously sealing the edges of the cut.
Cuts tissue via vibrations rather than heat
The LigaSure Vessel Sealing System allows hemostasis by vessel compression and obliteration through the emission of bipolar energy
thank you for watching !
www.covidien.com
National Safety and Quality Health Standards
Chloe Templeton
NSQHS, 2011, pg.3


The Australian Commission on Safety and Quality in Healthcare 2011, The National Safety and Quality Health Service Standards NSQHS, Sydney, p. 16-19

WorkSafe Victotia, 2013, Introducing Worksafe: A guide for Health Care Providers, Melbourne

The Australian Commission on Safety and Quality in Healthcare 2011, The National Safety and Quality Health Service Standards NSQHS, Sydney, p. 16-19

The Australian Commission on Safety and Quality in Healthcare 2011, The National Safety and Quality Health Service Standards NSQHS, Sydney, p. 3

The Australian Commission on Safety and Quality in Healthcare 2011, The National Safety and Quality Health Service Standards NSQHS, Sydney, p. 33
Karina tan
Natasha rich
chloe templeton
jessica taranto
Chloe templeton
jess taranto
Full transcript