4 9
J A N U A R Y 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
detects that less than 100% of the energy is returned to the genera-
tor, or if there's an insulation failure, the generator ceases to deliver
power. It's important to note that active electrode shielding has the
power to eliminate capacitive coupling and insulation failure during
laparoscopic surgery, but does not protect against pilot error such
as direct coupling.
6. identify only one of the following precautions to
take if a patient has a pacemaker or implantable
cardioverter defibrillator (iCD).
a. Electrosurgery is contraindicated and not safe
for any patient with a pacemaker or ICD.
b. ESU cords or cables are best placed closest to the devices.
c. Do not let the current transect the ICD or pacemaker,
with placement as far as clinically possible.
d. Maintain the longest distance between the active electrode and the pad.
answer: c
When using electrosurgery on a patient with an ICD or pacemaker, it
is generally suggested that bipolar electrosurgery is the better bet.
Monopolar electrosurgery can interfere with ICD or pacemaker con-
ductions. When using electrosurgery with these patients, avoid tran-
secting the electrical current through the heart, and place the active
electrode and plate as close as possible to each other to decrease the
current flow through tissue. OSM
Ms. Dennis (vdennis@spiveystationsurgerycenter.com) is the administrative director at Spivey Station
Surgery Center in Jonesboro, Ga.
