E-learning

Why was this not explained to us in medical school?

▻ Presumably as it only forms a small part of the medical studies.

Therefore, in addition to in-service training, we also offer numerous training courses, workshops, presentations, lectures and extensive e-learning courses. May be better: "Our experienced trainers will train you perfectly and tailored to your needs, whether you are a surgeon, medical student, clinical professional or biomedical engineer. 

For the safe application of electrosurgical instruments, there are numerous and not always intuitively understandable safety rules to be observed, which can only be explained via the physical principle of electrosurgery and the resulting effects.

Why may the patient not be grounded?

▻ Because this would cause uncontrolled leakage currents that may cause burns to the patient.

Leakage current occurs when the patient touches electrically conductive objects that have a connection to the floor – for example infusion stands or metal parts of the operating table. Depending on the current density and the activation time burns can occur at the contact points.

The neutral electrode is often misunderstood as grounding pad. In fact however, the opposite is the case.

In the monopolar technique, the electrical circuit is closed via the neutral electrode, which generates a low current density due to its large surface area. In this way the temperature at the neutral electrode remains "neutral". It is important to prevent grounding through uncontrolled leakage circuits.

Why can burns occur on other parts of the body?

▻ Because flammable gases can be ignited by electrical sparks in the surgical field. Fires repeatedly occur in this way.

In addition, grounded objects and constrictions in body parts can lead to high current densities and heat the tissue in unexpected body parts.

How should the neutral electrode be attached?

▻ In the case of oblong neutral electrodes, the long side has to face the surgical field and the current path.

This servesto distribute the current over a sufficiently large area over the surface of the neutral electrode so that the skin at the contact point does not become too hot during activation.

Nonetheless, activation must not last too long and sufficiently long pauses must be observed to avoid overheating the current path running through the patient.

What needs to be considered in patients with implants?

▻ The neutral electrode must not be attached over an implant such that the implant lies in the current path between the surgical field and the neutral electrode.

Metal is far more conductive than tissue. This is why metallic implants in the patient's body which are located in the current path quite literally attract the current. This can lead to high current densities and burns. In addition, active implants can be influenced or damaged by electromagnetic interference. Bipolar instruments are therefore preferable for patients with implants.

Observe the instructions given by the manufacturer of the implant. Consult the specialist and check the active implant for malfunctions after surgery. For monopolar applications, divert the current path away from the implant by suitably positioning the neutral electrode. Do not activate for too long and maintain sufficiently frequent and long activation pauses. Select the lowest possible unit settings.

Activation is too long, and activation pauses are too short.

▻ Prolonged activation and too short pause intervals can cause burns.

The longer the current flows, the more the current path in the patient is heated up - particularly if there are constrictions in the current path or if additional contacts are created.

The voltages selected are too high for the instrument used.

▻ This can damage instruments, cause sparking or capacitive coupling, resulting in a flow of current in nearby metal objects or cables. This can lead to burns as a consequence.

Voltages of up to several thousand volts are used in electrosurgical applications. However, the various instruments are not suitable for all adjustable voltages. Bipolar instruments in particular are generally less voltage proof. The maximum voltage to be applied must be specified by the manufacturer.

The patient is not positioned with sufficient electrical insulation.

▻ Burns can occur at the contact points to grounded objects, especially if activation is too long. The reason being that leakage currents can occur when the patient has contact and an electrical connection to the floor.

Attention is not paid to the fire hazard due to flammable gases.

▻ Fires and deflagrations can occur, which repeatedly lead to burns.

Depending on the selected mode, electrosurgical instruments generate sparks with the aid of high electrical voltage. If flammable gases have accumulated in the surgical field, this can lead to fires and deflagrations with sometimes dramatic consequences.

Examples include incorrectly applied disinfectants, excessive oxygen concentration during interventional bronchoscopy, intestinal perforations caused by exploding endogenous gases, nitrous oxide or hydrogen compounds.

The application site of the neutral electrode is not prepared correctly.

▻ This can lead to high current densities at the contact point. Therefore the neutral electrode must always be completely attached across its entire surface.

To prevent the neutral electrode from becoming detached during application, body hair as well as creams or liquids must be removed at the application site. The application site should not be located underneath the patient to avoid getting wet and to prevent pressure ulcers caused by the cable or the cable connection.

In addition, further rules for the selection of a suitable application site must be observed, which among other things, depend on the respective patient and the surgical site.