(About Energy Devices)
Instrument usage: Energy devices are used to control bleeding during surgical procedures and seal off vessels.1 There are many different types of energy devices that can be used, such as high frequency electrical current, ultrasound, bipolar electrosurgery, radiofrequency, cryoablation, and microwave ablation.1 The type of device will be chosen based on the type of surgery, surgeon preference, and patient condition. Energy devices are used in all types of procedures that are open, laparoscopic, or robotic.
Key differences:
High frequency electrical current can coagulate, cut, or do a blend of coagulating and cutting.2 The active electrode is the hand piece and the return electrode is the grounding pad that is placed on the patient.2
Ultrasound devices are used to remove or reduce tumors in highly vascular, delicate tissue, such as the brain, liver, kidney, and spleen.2 The ultrasound hand piece converts electrical energy into mechanical motion by vibrating at an ultrahigh frequency.2 The working end of the hand piece can be a scissor or a blade.2
Bipolar electrosurgery uses electrical current that goes through instrument prongs and back to the machine, not using a grounding pad.1 Advanced bipolar devices can seal vessels up to 7mm.1
Radiofrequency devices use low-frequency radio waves through electrodes that cause friction and increase the temperature of the tissue.1 There is a plate that is placed under the patient for the radio waves to return to the generator.1
Cryoablation devices use extreme cold to destroy tissue.1
Microwave ablation devices use a microwave antenna that is placed directly on a tumor so that the high temperature will destroy tissue.1
Safety on the sterile field:
When using high frequency electrical current, a suction evacuator should be used to prevent the patient and staff members from inhaling the plume or smoke that is generated by the device.2
When using high frequency electrical current, place the return electrode as close to the surgical site as possible, on a well-vascularized muscle. Avoid getting it wet and do not cut the grounding pad.1
When using high frequency electrical current, the hand piece should remain in the holder unless it is being used by the surgeon.2
Ultrasound devices should be kept clean at the tip by using a moist sponge. The scrubbed personnel should avoid letting the hot tip touch the patient because it can cause an unintentional burn.2
Bipolar cautery should be used on patients that have implantable electronic devices, such as pacemakers.1
All energy devices should be examined before use for cracks in the handpiece or cord, and checked to assure that they are in good, working order.
Placement of all energy devices should be carefully considered to avoid electromagnetic interference.1
Instrument names:
Energy devices are called by the type of device they are and the manufacture’s name, such as “vessel sealer” or “bipolar cautery” or “harmonic scalpel.” The high frequency electrical current devices are commonly called “ESU” for electrosurgery unit or “cautery” or “Bovie,” which is an older manufacturer of this device.
References:
1. Criscitelli, Theresa. Fast Facts for the Operating Room Nurse: An Orientation and Care Guide. Springer Publishing Company, 2021.
2. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.