Safety should always be paramount in a surgical setting to protect the welfare of both patient and healthcare professional. A safe environment is maintained not only by thought-through procedures and preparation, but also in the choice of surgical instruments used.
This can range from a medical device costing thousands of pounds to an affordable disposable item. This is why surgeons and theatre staff should give serious thought to using non-stick electrodes, especially in surgical diathermy.
What Is Diathermy?
Diathermy is an electrosurgical procedure during which electrically induced heat or high-frequency electromagnetic currents are used to facilitate haemostasis (a process that causes bleeding to stop, meaning to keep blood within a damaged blood vessel) and/or the cutting of tissue during surgical procedures.
The Dangers of Eschar Build-up
A significant issue in electrosurgical procedures is the build-up of eschar, a piece of dead tissue cast off from the surface of the skin, particularly after a burn injury. Eschar can amass on surgical instruments (such as electrodes) in such procedures, and this can create two risks. Firstly, the eschar build-up can impede the flow of electrical current in electrodes. Secondly, eschar is flammable, so it can become a fire risk.
The Risk of Direct Coupling
In terms of impeding electrical flow, eschar is inherently resistant to current, with the consequence that it inadvertently redirects the electrical current being put through the surgical instrument to body parts adjacent to the actual focus of surgery. This means that a previously focused electrical current is now being run through an unintended organ or structure, with all the attendant risks that could present. This is known as direct coupling.
The Dangers of Surgical Smoke
As for eschar being flammable, the first risk posed to both patient and healthcare professionals in the operating room is the generation of surgical smoke. The term ‘surgical smoke’ encompasses all the gaseous by-products created during electrocautery, laser surgery or the use of ultrasonic scalpels. It has been described as part of the ‘chemical soup’ that is present during the care of perioperative patients; one study found that the smoke produced in one day was equivalent to 27 to 30 cigarettes. While there are medical devices now widely available to remove surgical smoke at the point of surgery, prevention of (as well as solution to) surgical smoke should be undertaken, and this involves finding a way of minimising the build-up of eschar, which can be a source of surgical smoke in itself.
The second risk with eschar being flammable is, of course, that it could actually catch fire, which is a significant danger to the patient when surgery is being carried out in an area of the body where a large amount of oxygen is present (such as the throat or lungs). There has been a reported case of flames briefly flashing from the tip of an active electrosurgical electrode during a tonsillectomy. The patient involved was not harmed and in this instance no surrounding materials caught fire, but there was a real risk that the fire could have spread or caused significant injury.
Given these significant risks involved with eschar, surgeons and theatre staff have to be alert to such a build-up during surgical diathermy. At the very least, surgeons and theatre staff need to regularly clean medical instruments that are affected by eschar increase, but other solutions should also be sought.
Why Non-Stick Electrodes?
A sensible, cost-effective way for surgeons to mitigate against this is to use non-stick electrodes in diathermy procedures. By being coated in Teflon (or silicone), this helps prevent the build-up of eschar on the surgical instruments themselves, meaning that all the aforementioned risks are significantly minimised and that surgeons and theatre staff do not need to waste time during surgery removing as much as eschar accumulation as before.
The CIMPAX C-VAC TORNADO, distributed by Single Use Surgical, is available with a range of electrodes for a variety of surgeries, including Teflon-coated, and silicone-coated tips. To find out more about the CIMPAX Electrosurgical Pencil range, click here.