{"id":598,"date":"2022-12-15T13:42:46","date_gmt":"2022-12-15T13:42:46","guid":{"rendered":"https:\/\/perioperative1002.slc-courses.ca\/?p=598"},"modified":"2022-12-20T13:51:02","modified_gmt":"2022-12-20T13:51:02","slug":"module-5-c-ensuring-safe-use-of-energy","status":"publish","type":"post","link":"https:\/\/perioperative1002.slc-courses.ca\/?p=598","title":{"rendered":"Module 5: C. Ensuring Safe Use of Energy"},"content":{"rendered":"\n
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Ensuring Safe Use of Energy<\/h2>\n\n\n\n

\n Early electrosurgical units (ESU) were grounded units. This meant that the electrical energy was delivered to the patient from the generator and <\/a>returned to the ground. Since electricity always takes the path of least resistance, patients were at <\/a>an elevated risk for burns as the energy sought the quickest route to the ground. (That could have been through an IV pole that inadvertently was touching the patient\u2019s hand, for example. \n<\/p>\n\n\n\n

\n Today\u2019s ESU devices have been designed to force the electricity to return to the generator. This means the energy must flow through the patient and return through a dispersive electrode (grounding pad) or return through the other side of a bipolar <\/a>device to the generator. As a safety mechanism, If the generator does not receive the energy back, it will stop functioning.\n<\/p>\n<\/div>\n\n\n\n

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\n Dispersive electrodes return pads or grounding pads are <\/a>a wonderful way to ensure that energy leaves the patient in a specified route; however, <\/a>they are not without risk. Pad site burns can occur if the perioperative team is not careful. Dispersive electrode monitoring is a technology where the generator ensures that the grounding pad has adequate contact with the patient\u2019s skin to decrease the risk of a burn.\n<\/p>\n\n\n\n

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When placing a grounding pad, the following precautions must be taken<\/a>. The site for the grounding <\/a>pad must be: <\/strong><\/p>\n\n\n\n

  1. Well vascularized — energy travels easier through vascular tissue such as muscle. <\/li>
  2. As close as possible to the surgical site to limit the energy movement within the patient. <\/li>
  3. Placed flat and securely. Hair removal may be required to ensure a secure fit. If any part of the pad lifts off the patient, the surface area of the energy removal is decreased and places the patient at higher risk of burn. <\/li><\/ol>\n\n\n\n

    Use advanced technology such as dispersive electrode monitoring when possible. Dual foil pads allow the <\/a>generator to ensure good contact before allowing the unit to function.<\/p>\n\n\n\n

    (Ball, 2019) <\/p>\n<\/div>\n<\/div>\n\n\n\n

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    What to do When you Cannot Place a Dispersive Electrode Monitoring Pad<\/h5>\n\n\n\n

    \n Capacitive dispersive pads are great options for patients who have experienced large burns or have fragile <\/a>skin, such as those with skin disorders, neonates or gerontological.\n<\/p>\n\n\n\n

    \n These <\/a>are large reusable pads <\/a>that are placed on the OR table. The patient lies directly on top of the pad, or a thin drawsheet can be placed in between. Using the technology of capacitation, the surgical energy flows from the patient into the pad and back to the ESU.\n<\/p>\n\n\n\n

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    Patients Who Have Implanted Electronic Devices<\/h5>\n\n\n\n

    Part of the preoperative assessment includes inquiring as to whether a patient has any implanted electronic devices. This could include a pacemaker, defibrillator, nerve stimulator, or other implants such as an insulin pump or cochlear implant<\/a>. An implant could cause energy to pass through the device and damage it or cause it to malfunction. <\/p>\n\n\n