Specialist equipment. Electrosurgery (diathermy).

Electrosurgical (diathermy) devices use high frequency electrical current to generate heat, which can cut and coagulate body tissue. Diathermy may be used in either monopolar or bipolar mode. The patient’s skin should be evaluated before and after diathermy use. Correct use of equipment will ensure that skin integrity remains intact. The patient should not be in contact with grounded metal objects as the provision of an alternative pathway for the electrical current could result in a bum. Any metal parts of the operating table that could come into contact with the patient

should therefore be padded and jewellery and piercings should be removed before arrival in theatre.

In monopolar mode the electrical current flows from the generator in the electrosurgery apparatus to an active electrode, which is the surgeon’s tool. The current continues through the patient to an adhesive dispersive plate (the return electrode) that is placed appropriately on the patient’s body so that it is ‘earthed’ safely back to the electrosurgery unit, thereby preventing an electrical bum. The return electrode should be placed over a vascular, muscular area to promote electrical conductivity and to dissipate heat.

Shaving may be necessary as hair at the dispersive site prevents complete plate contact with skin. The plate should not be placed over bony prominences (this can impede return current), over implanted prostheses (there is a potential for overheating), over scar tissue or over areas distal to tourniquets where adequate tissue perfusion cannot be guaranteed.

In bipolar mode both active and return electrodes are combined within the same instrument. One prong of the bipolar forceps is active and the other is the return electrode. This system is safer because the patient does not form part of the electrical circuit and therefore a dispersive plate is not required. If the patient has a pacemaker, this is the system of choice to avoid a monopolar current passing through the heart. However, the low power, low voltage waveform used with this system means it is usually incapable of cutting.

‘Laser’ is an acronym for ‘light amplification by the stimulated emission of radiation’. There are several hazards regarding the use of lasers in surgery. Transmitted directly or reflected into the eye, laser light can potentially bum the retina causing a permanent blind spot. If it hits the head of the optic nerve it may cause partial or total blindness. Since the beam is virtually non-divergent, increasing the distance from the laser confers little safety benefit. Infrared laser light is perhaps more dangerous because it cannot be seen. The cornea, lens, and aqueous and vitreous humours should be considered risk areas. If the skin is exposed to laser radiation it can cause a burning sensation. Skin of sedated or anaesthetised patients must be shielded. When lasers are in use theatre staff should wear eye protection, doors should be locked and windows covered to protect those outside the theatre.

X-rays.

Precautions should be taken to protect theatre personnel from the damaging effects of exposure to ionising radiation, which are well understood compared with other occupational risks. In accordance with the Ionising Radiation Regulations 1999, staff who work with ionising radiation should limit exposure to no more than is reasonably necessary, and should exercise reasonable care while carrying out such work. Every employee who works with ionising radiation should make full and proper use of the protective equipment provided. The number of people present in theatre should be limited to those necessary for the procedure and those present must wear lead aprons. It is advisable for pregnant women to avoid X-rays because radiation may cause foetal abnormalities.

Signature of head nurse

Signature of head nurse

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