12

Perloperotive Considerotions

Proteciion of lhe pofleni in Surgery

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cumb-ent upon all members of the surgical department for all procedures.
ETECTRICAT AND FIRE HAZARDS

1. All connections must be secure. 2. The inactive electrode should cover a sufficiently large area of skin (relatively free of hair, whicir acts as an insulator) and be as close as possible to
the site of application of the active electiode in or-

Electrical and fire safety precautions are set forth in hospital policy and are carried out by the operating room.staff. Safety measures include the restricting oi smoking to desigrlated areas, determination of the safety of equipment before permitting its use in the operating room (by the engineering department), and the ongoing inspection ofequipment prior to each u$e. personnel must receive instruction for the safe operation of electrical equipment and then demonstraie their alililq to use the equipment safely. All personnel should receive special instruction regarding their responsibilities in case of fire. Flammable anesthetic
agents are rarely employed today. The electrosurgical unit should not be used in the mouth or pleural civity during the administration of high conc-entrdtions of oxygen. Disposable$rapes. gowns, head and shoe covchemicals. Flammable antiseptic solutions should not be used to prepare the skin when the electrosurgical unit is used.
ELECTROSURGERY

through the body. 3. The patient's body should not make direct contact with metal surfaces. If the return circuit is faulty, the ground circuit could be completed through the contact area, thus creating an inadvertent burn
lnJury.

der to minimize the pathway of the current

4. Electrocardiogram electrodes should be placed. far away from the operative site as possible.

as

thoroughly investigated by the circulator. Check all

connections and the dispersive pad; if no problem is found, the unit may be faulty. Turn the unit off and unplug it.

Repeated requests to increase the current should be

erings, and so on are treated with flame-retardant

trosurgical unit could cause malfunction. The patient

SpeciolNotes If the patient has an implanted pacemaker, the

el.ec.

cart (complete with defibrillator and paddles) should be in close proximity.

OPERATIVE RECORD

needs to be continuously monitored. The cardiac auest

The electrosurgical unit is commonly employed in all the surgical speclalties for the purpose ofcoigulating or cutting tissue. The current flows from the generaioi (electro_surgical unit) to an active electrode thiough tisBue and returns to the unit through an inactive electrode. In the monopolar electrosurgical unit the active electrode is usually an "electrosurgical pencil" and the inactive electrode is the dispersive (grounding) pad. In the bipolar unit the active Llectrode'is one si"de of the forceps and the inactive electrode is the other side of the forceps; therefore, no dispersive pad is necessary. Precautions niust be taken when employing electiosur-gery inprder to prevent injury to the patient. These include the following:

The legal rights ofthe patient as well as those ofoperating room personnel are protected by the documentation in the patientls operative record. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that the operatiu" p"o."irr" report include the preoperative diagnosis, the procedu"e per-

intraoperative care. The docurnenlation of other information such as the taking of counts.(e.g., sponges, sharps, and instruments), placement bf cithet-ers, intravenous lines, wound packing, and use ofequipment

formed, the postoperative diagnosis, specimens obtained, and the names gf the surgical team providing