Transcript Slide 1

SURGICAL
MODALITIES
EL PASO COMMUNITY COLLEGE
SURGICAL TECHNOLOGY
PROGRAM
MARGARET M. RODRIGUEZ,
INSTRUCTOR
UNIT TITLES
ELECTRICITY, ELECTROSURGERY
AND FIRE SAFETY
IONIZING AND NON-IONIZING
RADIATION
ULTRASONIC AND HYDRODISSECTION
DEVICES
ENDOSCOPY/MINIMALLY INVASIVE
SURGERY
UNIT TITLES
MICROSCOPES AND MICROSURGERY
ROBOTICS AND GUIDED IMAGERY
I. ELECTRICITY, ELECTROSURGERY
AND FIRE SAFETY
GLOSSARY OF TERMS
ELECTRICITY – a
fundamental entity of
nature usually used as
electric current
CONDUCTOR
Any substance, medium, or material that allows
the transmission of electricity (flow of free
electrons)
Examples: metals, carbon, salt water, humans
INSULATOR
A medium that does not allow the transmission
of electricity by inhibiting the flow of electrons.

A non-conductive material such as rubber, glass,
porcelain, or wood.
ELECTRICAL CHARGE
ALL MATTER CONSISTS OF ATOMS
ATOMS ARE COMPOSED OF:



Protons – positively charged particles
Neutrons – particles with no charge, neutral
Electrons - negatively charged particles
ELECTRICAL CHARGE
When electrons move from one atom to
another, an imbalance occurs.
An atom which has lost electrons will carry
a positive charge.
An atom which has gained electrons will
carry a negative charge.
ELECTRICAL CURRENT
THE MOVEMENT OF ELECTRONS
THROUGH A CONDUCTOR
Example:
a light bulb illuminates
because electrons move through the
conductor of wires and metal base to the
tungsten filament in the bulb. The filament
heats up and brightens – producing light.
ELECTRICAL CURRENT
Current


The rate at which electricity flows.
Measured in amperes.
TYPES OF ELECTRICITY
Alternating Current (AC) – a
current that periodically
reverses its direction of flow.

Power from external power plant
Direct Current (DC) – a current
flowing in only one direction.

Battery power
ELECTRICAL TERMS
PATH OF LEAST RESISTANCE - electricity or
the flow of electrons will act like water and always
seek a path from highest concentration to lower
concentration via the easiest route.
ELECTRICAL TERMS
CURRENT LEAKAGE
- all electricity can
leak causing the
potential for shock.
ELECTRICAL TERMS
Ampere – the practical unit of
current strength.

The amount of current flowing in
a circuit. The rate of flow.
Ohm – the unit of electrical
resistance of a conductor

Measurement of the ability of a
material to receive flow of
electrons.
ELECTRICAL TERMS
Volt – the unit of electromotive force that moves
electrons through a material. It induces current
to flow in one direction.

The higher the number of volts, the more direct the
current
Voltage – the potential energy of electrons.
Electromotive force of an electric current
expressed in volts.
ELECTRICAL TERMS
Resistance – the opposition to
the passage of a current.
impedes or restricts the flow of
electrons

Measured in ohms
ELECTRICAL TERMS
GENERATOR – creates a force or voltage and
moves electrons from one point to another.

Like a plumbing system that utilizes a pump to create
water pressure and move water from one place to
another
ELECTRICAL TERMS
CIRCUIT - A moving or
traveling around. In
electricity, the entire course
traversed by an electric
current. When complete, it
is a closed circuit, when
interrupted, it is a broken
circuit.
ELECTRICAL TERMS
POWER – the rate of the movement of
electrons from point to point or current flow.


Power = amps or current x voltage
Power is measured in watts
ELECTRICAL TERMS
LOAD – the device that uses the electricity to
perform some type of function

The load can change the amount of energy delivered
from the power source
Examples: surgical lamps, ESU, video monitors
ELECTRICAL TERMS
SWITCH – a device
used to open or close
a circuit and controls
the flow of electricity.
ELECTRICAL TERMS
HOT WIRE – the wire that connects to the
switch.
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In polarized plugs, hot wire is smaller prong
Often the hot wire is colored red
ELECTRICAL TERMS
NEUTRAL WIRE – serves as the pathway for the
electrons to return to the energy source and
completes the circuit.


In a polarized plug, it is the larger of the prongs
Wire is often colored green
ELECTRICAL TERMS
GROUND – the connection of an electrical
current or circuit with the earth through a
conductor. Safely conveys any leaking
electrons to alternate path to ground.

Ground wires are often colored black
ELECTRICAL TERMS
Hertz – a unit of electromagnetic wave
frequency, equal to one cycle of alternating
current (AC).

Each cycle starts at zero – flows in the positive
direction, changes to negative, then back to zero
ELECTRICAL TERMS
FREQUENCY – the number of waves passing
through a given point per one second. This is
measured in hertz.
TYPES OF ELECTRICITY
STATIC ELECTRICITY – caused by friction and
accumulates on objects

When two static-bearing objects come in contact, the
one bearing the higher potential discharges to the one
with the lower potential creating SPARKS.
STATIC ELECTRICITY
An electrostatic charge or spark between two
objects can occur only when there is no pathway
of conductivity between them; therefore the chief
aim is to provide a manner of dissipating the
static accumulation.
STATIC ELECTRICITY
Common environmental hazard
in the OR
Does not cause patient shock or
burns
However, its production of an
electrostatic spark is its main
hazard because this provides a
source of ignition for a fire.
STATIC ELECTRICITY
Risks have diminished
because explosive
anesthetic agents are no
longer used.
STATIC ELECTRICITY
PREVENTATIVE MEASURES INCLUDE:

Good conductive floors prevent accumulation by
providing a pathway of conductivity between persons
and equipment coming in contact with the static
electricity.
STATIC ELECTRICITY
PREVENTATIVE
MEASURES

Safe furniture is made of
electrically-conductive
materials or contact to the floor
is made through electricallyconductive leg tips, casters, or
wheels.
STATIC ELECTRICITY
PREVENTATIVE MEASURES

Operating room floors are cleaned
with materials that do not reduce
conductivity.
STATIC ELECTRICITY
PREVENTATIVE MEASURES


Avoid wool and synthetic fabrics that
have not received anti-static
treatment.
Use cotton blankets, towels, etc.
STATIC ELECTRICITY
PREVENTATIVE MEASURES

Use special anti-static liners in
trash and linen hampers and kick
buckets.
STATIC ELECTRICITY
PREVENTATIVE
MEASURES

Maintain room humidity
level at 50-60%
STATIC ELECTRICITY
PREVENTATIVE MEASURES

Dissipate charges by frequently touching metal
surfaces and avoid friction causing activities.
example: avoid movement around patient’s head, especially
if his/her hair is uncovered.
ELECTRICAL SHOCK
ELECTROCUTION –
the most severe case
of electrical shock,
often lethal.

Occurs when a person
becomes part of the
circuit or closes the
circuit.
ELECTRICAL SHOCK
MACROSHOCK – requires a substantial voltage
to drive electrons through a highly resistant skin
path.

Can range from small tingling to electrocution
Due to things such as frayed electrical cords, spilling of liquids
on generators, radio with no back covering, or removal of
ground plug.
ELECTRICAL SHOCK
MICROSHOCK – electrical shock below
the level of sensation so can come from
undetectable sources.

Requires only a small amount of current but
must involve passage through the heart to
cause damage. If so, can also be lethal.
Incidents usually arise from equipment failure, wet
floors, ungrounded stretchers, or indwelling
catheters/monitors, etc.
ELECTRICAL HAZARDS
PRECAUTIONS
INSPECT THE POWER CORD AND PLUG
BEFORE EVERY USE
PRECAUTIONS
DO NOT USE EQUIPMENT ON WHICH
LIQUIDS HAVE BEEN SPILLED.
PRECAUTIONS
NEVER STACK THINGS ON OR BEHIND
ELECTRICAL EQUIPMENT WHICH MIGHT
INTERFERE WITH PROPER VENTILLATION OF
THE DEVICE.
PRECAUTIONS
TWO-PRONG
EXTENSION CORDS
OR ADAPTORS
SHOULD NOT BE
USED IN THE OR.
PRECAUTIONS
USE THREE-PRONG
EXTENSION CORDS
ONLY WHEN
NECESSARY
PRECAUTIONS
DO NOT RUN OVER
POWER CORDS
WITH WHEELS OF
EQUIPMENT
PRECAUTIONS
DO NOT TIGHTLY
COIL OR KINK
CORDS.
PRECAUTIONS
ALWAYS PLUG PORTABLE EQUIPMENT
INTO THE WALL OUTLET AND TURN
POWER ON PRIOR TO MAKING ANY
CONNECTION TO THE PATIENT.
REMOVE ANY PATIENT CONNECTIONS
BEFORE TURNING OFF POWER OR
UNPLUGGING FROM WALL.
ISOLATED SYSTEMS
ISOLATE O.R. ELECTRICAL SYSTEMS
FROM GROUNDED CIRCUITS IN THE
POWER MAIN OF THE HOSPITAL


Current flows from one isolated line to another
Line isolation monitors check the degree of
isolation by continuously measuring
resistance and capacity between two isolated
lines and ground
ISOLATED SYSTEMS


If the current leakage
exceeds safe levels,
an alarm sounds
Unplug the last piece
of equipment plugged
in and tag for repair
ELECTROSURGERY
Application of electrical current to
coagulate or cut tissue
The electrosurgical generator provides the
power for electric current to travel directly
to tissue and utilizes alternating current
(AC)
ELECTROCAUTERY
Term often used to mean electrosurgery
but is distinctly different
Electrocautery utilizes direct current (DC)
via heated wire to burn tissue.
No electricity passes through patient’s
body
HISTORY OF
ELECTROSURGERY
In ancient times,
people used hot
pokers, etc. to burn
bleeding flesh to stop
the flow.
HISTORY OF
ELECTROSURGERY
In 1926 Harvey
Cushing, a
neurosurgeon and
William Bovie, a
biophysical engineer
developed an
electrosurgical unit for
neurosurgical
procedures.
HISTORY OF
ELECTROSURGERY
By the early 1930’s,
the first commercial
“Bovie” units were
produced and being
used in operating
rooms.
BENEFITS OF
ELECTROSURGERY
Reduction of intraoperative and post-operative
hemorrhage
Decrease in operating time
Reduction of patient morbidity
It has become one of the most commonly used
surgical devices in all surgical specialties
ELECTROSURGERY
Energy produced is
high frequency radio
waves in excess of
100,000 hz
Produces
approximately 2000
degrees F of heat
when met with
resistance (such as
human tissue)
ELECTROSURGICAL MODES
MONOPOLAR – electrical energy flows
from a generator to an active electrode
such as Bovie (ESU) pencil and tip to the
patient with some result on tissue
Then out via the inactive electrode (or
dispersive ground pad) and back to the
generator
MONOPOLAR MODE
The path of electrical energy in a
completed ESU circuit is:

Wall plug > ESU generator > active electrode
(pencil tip or endoscopic inst) > patient >
inactive electrode (ground pad) > ESU
generator > wall plug
MONOPOLAR MODES
Monopolar energy of the ESU can be set for pure
cutting, pure coagulation, or a blend of cutting and
coagulation.


Cutting mode – can achieve effects by using less voltage
because the frequency is higher
It vaporizes tissue but does not dissipate heat to
surrounding tissue.
MONOPOLAR MODE
Coagulation mode – uses more dissipated
heat to cause hemostasis of blood vessels
by producing coagulum and char to seal
off.
Causes more damage to tissues and may
inhibit healing of tissues if used too much
Current may be applied to hemostat
placed on bleeding vessel to cauterize
Is not appropriate for large bleeding
vessels
MONOPOLAR MODE
BLENDED MODES voltage and frequency
are changed
Tissue results are a
mix of cutting and
coagulation
MONOPOLAR MODE
Endoscopic instruments may be electrified
by attaching a cord to a metal prong on
the instrument
Power is activated by foot pedal
May be used for either cutting or
coagulation modes
The patient MUST be grounded when
monopolar current is used
MONOPOLAR MODE
Capacitive coupling – unintended
electrical energy delivered to non-target
tissues.


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Occurs during laparoscopic procedures where
visibility is limited
Occurs as a result of insulation failure
May be prevented by shielding devices
Burns to internal organs are potentially fatal
PERSONNEL HAZARDS
Electrical shock may be delivered to surgeon or
assistant due to:


Tiny hole in latex surgical gloves
High setting on ESU causing hole in glove and
subsequent burn – called dielectric breakdown
PERSONNEL HAZARDS
VAPORIZED TISSUE PLUME – may
contain hazardous ingredients such as
carcinogens, bloodborne pathogens, and
viral particles


Smoke evacuators should be utilized when
large amounts of plume expected
Special filtration masks should be worn for
laser plume cases
BIPOLAR MODE
Electrical current passes only between the
two prongs of the instrument and through
any tissue in between.
Used for delicate procedures to reduce
possible nerve damage.
Patient does not need to be grounded
because the entire patient is not included
in the circuit, only tissue between tines of
instrument
GROUNDING PAD
Also known as inactive electrode or
dispersive pad
Must be in complete contact with patient to
prevent electrical burn to patient
Should be placed over a large muscle
mass, NEVER over bony prominence, joint
with prosthetic replacement, or over metal
implants
Should be located as close to surgical site
as possible
GROUNDING PAD
Keep as far away from pacemakers as
possible
Should be placed after final positioning to
prevent change in contour
Should be removed following case after
drapes are removed
Pad site must be inspected postoperatively and result charted
Pads are available in different sizes
appropriate to size of patient (pediatric,
neonatal, adult)
GROUNDING PAD
Must NEVER be cut
Must NEVER allow prep solutions to pool
under pad
Ground pads sites are the major area
where ESU burns occur

ECG leads provide second most common
burns due to alternate exit pathway of
electrical current