Equipment Utilization (Manufacturers Recommendations)

Guidelines:

• The perioperative nurse:
  • Is responsible and accountable for the safe use of a variety of different devices and pieces of equipment
  • Must understand the technical components of surgical equipment that will be utilized during surgery
  • Must always refer to manufacturer’s instructions for use (IFU) proper
  • Must understand the difference between monopolar and bipolar systems, and dispersive pad considerations
  • Must understand and apply safety practices to prevent surgical fires, surgical smoke, and burns/injuries from equipment in the OR

Considerations:

• Electrosurgery units (ESUs)
  • Cut and coagulate tissue
  • Associated with numerous patient injuries
  • Two modes for cutting or coagulation: Monopolar or bipolar
    • Monopolar: patient completes the electrical circuit. Most common mode. Dispersive electrode pad needed.
    • Bipolar: Energy returns directly through the instrument to the generator to complete the circuit. No dispersive pad needed.
• Patients with piercing jewelry should have jewelry removed before surgery (increased risk of electrical burns). If not possible, an alternate energy-generating device should be used.

Nurse’s role:

• Patient Advocate
• Principles of patient/personnel safety
  • Controlled access, appropriate patient/personnel protection for laser surgeries
• Instruments, supplies, and equipment related to surgical procedure
• Equipment use per manufacturer’s IFU
• Apply the nursing process framework to equipment utilization practices

Pitfalls:

• ESU pencil should be placed in safety holster when not in use
• Electrosurgery devices must not be used near flammable liquids, instruments, or other supplies. Can serve as the ignition source for a fire if flammables and an oxygen-enriched environment are present
• Power settings on ESUs must be verbalized to the surgeon at the beginning of each procedure
• The scrub person removes any charred material from the ESU pencil blade or tip
• Fire safety and prevention of burns is a safety priority

Examples:

• You are doing a preoperative assessment on a patient undergoing laparoscopic surgery. You understand that the use of ESU in laparoscopic surgery places the patient at risk for burns from the ESU. What are some preparations you would ensure your patient does not experience any adverse outcomes from ESU burns during surgery?
  • Ensure the patient does not have any metal jewelry
  • Educate patient on the risk of burns from metal body piercings/jewelry
  • Check that the ESU in the OR has been cleared with your organization’s biomed department and is working properly
  • Ensure that foot pedals for the ESU are in a safe location close to the operator of the ESU pencil.
  • Apply dispersive pad for surgeries using monopolar energy. Make sure pad is well secured to site close to operative site.
  • Verbalize ESU settings with the operator prior to start
  • Check that volume on alarm for ESU is audible for surgical team
  • Deliver saline to backtable prior to surgery start
  • Make sure ESU pencil is placed in holster when not in use and not laying on drapes
  • Do a skin assessment after the drapes are removed to ensure no burns are present and that the skin is intact around the dispersive pad site.

Linchpins (Key Points):

• The manufacturer’s IFU is the bible
• Be the patient advocate
• Prioritize patient safety