Diathermy has a long history of use and a generally good safety record. Surgical diathermy has been around for 50 years and is a trusted surgical aid. Despite significant advancements in medical electronics, the original diathermy design hasn’t changed much over the years.
It is pivotal to know that diathermy, particularly in association with other equipment, is much more complex than is generally realized.
However, patients who undergo electrosurgical procedures run the risk of suffering burns and unwanted electrical stimulation.
Therefore, understanding the equipment used is necessary for safe diathermy execution and its use with other equipment. Before utilizing such equipment, it is necessary to know the earthing configurations of the various electrodes to interconnect them safely.
The need for expert advice arises because few people possess the training or tools to conduct the required tests.
Many hospitals have an in-house biomedical engineer or electronics technician who can test the grounding part. Where doubt exists, obtain all necessary information from the manufacturer or distributor. The following tested and robust methods should enable safe diathermy use given the configuration of the equipment:
- Test & Inspect: The diathermy machine and related equipment should be kept in a safe working condition, paying close attention to adequate earthing and the plate’s lead continuity. This requires regular testing and inspection by qualified engineers.
- Isolate: Only “fully isolated” models or an alternative design of equal safety should be considered when purchasing new equipment.
- In addition, before using the device, verify the plate lead’s continuity. If the machine has a built-in plate monitor, ensure it works before using it.
- Apply the diathermy plate carefully, ensuring good contact across the largest area. The plate must be completely clean and have no ridges.
- Also, ensure the patient is not in contact with any metal components. Take precautions for any other metal contact, such as surgical staples or silver amalgam tooth fillings.
- Earthing & Grounding: Any other apparatus connected to the patient and earthed at diathermy frequencies MUST be connected if the diathermy plate is directly grounded. The diathermy plate should be the closest earthed point to the surgical site.
- Dispersive Pad: A dispersive electrode/pad is unnecessary when using a bipolar electrosurgery unit as current flows from tip to tip.
- A dispersive pad must be used if monopolar devices are being used concurrently.
- The pacemaker circuits may be hampered using a monopolar mode, so whenever possible, operate using bipolar only.
- Power Supply Settings: Be aware of power loss conditions, especially when more electronic appliances, such as video cameras, OT lights, etc., are used during procedures.
- Request for much higher power supply settings than are currently available.
- Never increase the power without first checking the plate and plate lead if a machine that is known to produce enough power at a certain setting doesn’t.
- A damaged plate circuit almost always results in a sudden loss of power.
- Smoke Evacuation: The smoke from electrosurgical units cannot be prevented, but it is necessary to keep the area from dangerous gases. HospitalBuy offers AoneS smoke evacuators that consist of unique 5-stage filtration that ensures complete filtration and disinfection of surgical smoke in the operating room.
- Skin Contact: Avoid skin-to-skin contact as this blocks the path from the surgical site to the return electrode, which can result in burns at an alternate site. Place the patient in a position where the return electrode path is clear.
Electrosurgery is effective and safe when the basic protocol is followed. Lastly, while defining the medical-legal considerations, concentrating on the regular maintenance or calibration of electrosurgical devices can help prevent complications or unfavorable events brought on by their use.
Meditorch’s HospitalBuy is happy to offer an affordable, customized repair and maintenance service for electrosurgical units, ensuring electrical safety and improving unit performance. We can help you with everything from robust power tool repair to replacing ESU’s intricate accessories. Allow our team to help meet your needs!
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Q1: How to increase the lifespan and viability of electrosurgical units?
A1. An ESU’s lifespan will be extended if the usage guidelines outlined in the operation manual are followed. As an illustration, most ESUs mandate a 10-second cut time, followed by a 30-second rest period. After supplying the intense energy needed to produce an output, this pause enables the device’s circuitry to cool.
- Regular cleaning is another simple way to extend the lifespan of any electrical equipment. Due to decreased airflow inside the unit, dust accumulation alone can make units operate at a higher temperature and harm the power components.
- It’s not always simple to increase an electrosurgical unit’s lifespan. Careful use and routine cleaning are required to get the most out of any device.
- Regular maintenance will also increase an ESU’s lifespan. The unit will be thoroughly tested against the manufacturer’s specifications during routine maintenance, allowing any problems or potential problems to be found.
Q2. What are some preventive maintenance procedures, and why are PMs crucial for ESUs?
A2. Every medical device needs preventative maintenance (PM), and ESUs are no exception. A typical PM inspection would adhere to the testing procedure specified by the manufacturer in the service manual.
- The output test, the return electrode monitor (REM) function test, and the leakage test are the three most crucial tests in a PM. During output testing, the Biomed personel will turn on the unit and monitor the energy delivered to an ESU analyzer that has been calibrated.
- The technician will then take note of this measurement and compare it to the acceptable energy range specified by the manufacturer. Another crucial test is the evaluation of the REM function. The Return Electrode Monitor, or REM function, offers a seamless pathway for energy flow from the ESU to the patient. A problem with the REM circuit could prevent the ESU from performing monopolarly, which could be harmful.
Q3. What happens if the ESU is not calibrated regularly?
A3. The desired surgical results cannot be obtained if the ESU is not calibrated regularly. (For instance, a surgeon must increase output power above the standard setting because the desired surgical result won’t be achieved at the regular low levels, and a higher power level will result in unwanted charring and tissue destruction.)
- The operating surgeon, staff, and patient may be at risk if the electrosurgical unit is not calibrated as it falls under the CLASS iiB category (high risk).
- Croke L. Best practices for reporting electrosurgical unit malfunctions. AORN J. 2020 Jul;112(1)
- Link T. Guidelines in Practice: Electrosurgical Safety. AORN J. 2021 Jul;114(1):60-72