The following praiseed practices w...

The following praiseed practices were developed by the AORN make acceptableed Practices Committee and have been approved by the agency of the AORN Board of Directors. They were quick in emergenciesed as proposed recommended practices for remark to members and others. These commited practices are effective Jan 1 2004

These attract favor toed practices are intended as achievable recommendations representing what is believed to be an optimal of the same height of practice. Policies and steps will reflect variations in practice settings and/or clinical situations that determine the rank to which the recommended practices can be implemented.

AORN recognizes the various settings in which perioperative supply with nourishments practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where surgery may be performed.

PURPOSE: These attract favor toed practices provide guidance to perioperative feed at the breasts in the use and care of electrosurgical equipment. meet care and handling of electrosurgical equipment is essential to patient and personnel safety. Electrosurgery is used routinely to chop coagulate, dissect, fulgurate, ablate, and shrink material part tissue with high frequency (ie, radio frequency) electrical present Ultrasonic dissectors dissect tissue by dint of vibration. Vessel sealing devices use a combination of urgency and heat to permanently occlude ducts These recommended practices address all of these technologies and do not endorse any specific product

attract favor toed PRACTICE I

Personnel selecting the electrosurgical unit (ESU) and accessories for purchase or use should make decisions based forward safety features to minimize risks to patients and personnel

1 Equipment exquisiteed should include technology to bring to light stray current that could conclusion in patient injury and to alert the user of this condition. Electrosurgical units are high-risk equipment. Historically, the greatest in number frequently reported patient injury has been a skin injury (eg burn) at the dispersive electrode site. (1) The risk of this token of injury has been minimized by the agency of advances in dispersive pad design (eg nondrying conductive material, dual-contact dispersive electrodes) and the use of get back electrode contact quality monitoring. (2) Minimum safety standards for ESU orders have been developed by the Association for the Advancement of Medical Instrumentation and approved by means of the American National Standards Institute. (3)

2 Equipment should be designed to minimize the risk of alternate site injuries. These injuries can rise from use of ground referenc (ie, spark-gap) ESUs that allow electrical general to seek alternate pathways to total the circuit. (3, 4) The use of isolated (ie, solid-state) ESUs has minimized this risk.

3 Equipment should be designed to minimize the risk of capacitive coupling injuries. During minimally invasive practices alternate site injuries have springed from insulation failure and capacitive coupling. (4 5-11) These injuries are real serious and have increased in number with the increased use of laparoscopic surgery (12) The use of active electrode monitoring has minimized these risks. (13-17)

4 Equipment should be designed to minimize unintentional activation that could eventuate in patient and personnel injury. Audible activation tones minimize this risk. (3 18-19)

5 Electrosurgical accessories single outed should be compatible with the equipment and other accessories. Injuries have comeed when equipment intended for bipolar use is inserted into monopolar connectors and, subsequently inadvertently activated. (20) Appropriate matching and use of accessories minimizes this risk.

6 Electrosurgical technology continues to unroll changing the way in which surgical hemostasis is achieved. It is the responsibility of each facility to stay abreast of evolving technology and its impact onward patient care and safety.

commited PRACTICE II

Personnel should demonstrate suitableness in the use of the ESU and accessories.

1 Personnel working with electrosurgery should be knowledgeable about the principles of electrosurgery risks to patients and personnel measures to minimize these risks, and corrective actions to enlist in one's service in the event of a fire or injury. Electrosurgical equipment and accessories have been associated with numerous fires and patient injuries. (1 11 21-22) The National Fire Protection Association has identified ESUs as high-risk equipment, warranting training and retraining of personnel (23) Personnel should be instructed in the just operation, care, and handling of the ESU and accessories before use. (23) Initial education of the underlying principles of electrosurgical safety provides direction for personnel in providing a safe environment. Additional, periodic educational programs provide reinforcement of electrosurgery principles and just discovered information on changes in technology, its application, compatibility of equipment and accessories, and potential hazards.