ment and eliminate that risk. You can't get a dispersive electrode burn
if you don't have electrodes.
I also opt for bipolar in pregnant women, and in people with pace-
makers, so I don't have to worry about electromagnetic interference.
Monopolar energy tends to be a little more precise and a little less
expensive, but also a little more dangerous.
6
Beware of insulation failures. One of the challenging realities
about insulation failures is that the smaller the defect, the worse
the result is likely to be. If all stray energy goes to a very small
area, the more severely the tissue in that spot will be affected.
You should always inspect instruments with your eyes before using
them, but there are also specific tools with sensors that detect insula-
tion defects. All hospitals and surgery centers should be using them
when they reprocess instruments.
Modern-day electrosurgical units monitor the energy flowing
through the system and shut down if energy is leaking out. That's
reassuring. But there's still the potential for injury to occur right as
the machine is detecting the problem. In other words, there's an
added level of protection, but the same level of vigilance is always still
required.
7
Beware that injuries can happen outside the field of vision.
Injuries outside the field of vision are rare, but they may also be
the most concerning. If you detect a burn while surgery is hap-
pening, you can repair it. But if you don't see, for example, a bowel
perforation, you can end up with a life-threatening injury. Patients
have actually died from such occurrences.
It's critical to keep all active parts of the instrument in the view of the
camera at all times. If you zoom in too close, you can miss something.
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