Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/153372
S U R G I C A L S A F E T Y efforts, but their consequences can be just comes to patient warming, don't just set it standing of how electrosurgery works. monitoring device can also alert you to as severe as those of a flash fire. The and forget it. That's why routine inspection, testing, insulation breakdown while performing its maintenance and staff training are essen- preventive task of overseeing the electro- tial to electrosurgery safety. surgical current — and shutting it down if improper use of patient warming devices, It's possible that thermal burn injuries and of convective (forced-air) warming sys- are underreported or initially unobserved, tems in particular, is a main offender on like medical error near-misses. But now • Direct coupling is the result of an active this front. that patient burns are reported as a data monopolar electrode touching an uninsu- quality measure, perhaps we'll see more lated metal object, which conducts the tem incorporates a forced-air unit connect- awareness raised of patient warming's current to adjacent tissue. Most physicians Never again ed by hose to a single-use patient blanket potential danger. who employ electrosurgery know to avoid Patient burns in the perioperative setting touching devices' tips to other metal are 100% preventable, but awareness, edu- The design of a convective warming sys- or gown, which diffuses the hot air. Safety it detects stray energy, to minimize potential injuries. authorities have reported incidents in Stray energies instruments or implants, but even metals cation and action are required to ensure which facilities neglected to purchase or In addition to their potential role as heat outside of the immediate operative site, patients remain safe in your care. By com- use the disposable components and and ignition sources in OR fires, electro- such as the surgical table, positioners, municating the risks to staff, reporting inci- instead placed the hose directly under a surgical instruments may also pose a risk stands, poles and gown snaps, can also dents and utilizing available guidance, you'll cloth blanket. This practice, called "free for burn injuries through stray electrical conduct current and should be adequately ensure these never events never occur on hosing," puts patients at risk of severe current. If such injuries occur during covered. your watch. OSM burns, especially if they're anesthetized, laparoscopic use and out of the surgeon's • Capacitive coupling can unintentionally asleep or immobile as the forced hot air direct line of sight, they may not even be burn tissue or skin when electrical current blows unceasingly at their skin. noticed until the patient suffers post-op passes between conductors (even insulat- (and post-discharge) complications as a ed ones) that are close to each other. This result. is sometimes the result of current leaking Safe patient warming depends on the proper use of warming systems. Always consult and train your staff to observe the Careful handling and use of electrosurgi- Ms. Burns (mmb g @lig httub e.net) is director of clinical affairs and medical education for Symmetry Surgical, and a business consultant for the Surgical Group of Tullahoma (Tenn.). through damaged insulation, which under- manufacturers' directions. Assemble the cal equipment can prevent burns from scores the importance of routinely inspect- devices correctly, and discourage free hos- direct but unintended contact between ing the condition of electrosurgical units' ing when convective systems are used. Set active electrodes and tissue, or from acci- insulation. Even breaches that aren't visi- the warmers to appropriate temperatures dental device activation. Burns resulting ble to the naked eye can be hazardous, so that are acceptable to patients, and return from direct or capacitive coupling require consider the use of an insulation scanner for occasional checks on them. When it another level of caution, and a full under- HEAT IS ON Light sources and other electrical equipment can generate enough heat to burn through drapes. Mike Shelton, RN, demonstrates for clinical manager Kristen Barnes, RN (left), and Jennifer Barbeau, RN, at Tullahoma Surgery Center. while setting up cases. An active electrode- 2 0 SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | J A N U A R Y 2013 J A N U A R Y 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 2 1