1. What is the most common complication when using a radiofre-
quency surgical instrument?
a. direct application
b. capacitive coupling
c. fire
d. surgical smoke
a. The most common injury when using radiofrequency devices is a
direct heat or direct application injury, says Dr. Robinson. These
injuries occur when the surgeon holds the tip of the activated, hot
instrument too close to vital tissue, which is then unintentionally
burned. "While it seems like this is an obvious issue, and one that
should be easy to prevent, 30% of all surgical energy-based device
complications reported to the FDA occur via this injury pattern," says
Dr. Robinson. "But because it's not as headline-grabbing as surgical
fires or capacitive coupling burns, it doesn't get as much attention."
To help prevent this complication, remind surgeons and staff that they
must remain vigilant to ensure the electrosurgical device's tip does
not get too close to vulnerable tissue.
2. True or false: The safest electrosurgical modality is bipolar
radiofrequency.
False. All electrosurgical devices have roughly the same level of risk
and are safe to use if you follow the manufacturer's instructions for
use and follow proper precautions, says Byron L. Burlingame, MS,
RN, BSN, CNOR, a senior perioperative practice specialist with the
Association of periOperative Registered Nurses (AORN). There are a
few exceptions, though. "Alternative technologies should be used
instead of monopolar electrosurgery if there is a high risk of fire or if
there is an implanted medical device within the pathway between the
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SURGICAL
ERRORS
