Diathermy Wednesday, September 30, 20 Diathermy - Device that uses high frequency alternating current between 2 electrodes and through tissue to produce heat to either cut or coagulate the tissue - 2types © Monopolar * Using high-power generator (400W) = Current is generate in the diathermy machine the passed to hand-held electrode = An the tip of electrode | Current density high - resulting in very high temp locally The current then dissipates over a large amount of tissue at the patient plate electrode c_ The current goes back to the machine 12:07 PM © Bipolar * Current is passed from one electrode to another across a small amount of tissue * 2 electrodes incorporated into a pair of forceps * No need for plate © Requires much less power (SOW) - Diathermy setting © Cutting * Continuous output from generator * Temperature up to 1000'C are produced © Cellular water is instantly vaposized, causing tissue disruption without much coagulation © Coagulation * Pulse output from diathermy generator result in the sealing of blood vessels with minimum of tissue disruption - Blend © Setting for monopolar diathermy © Continuous output with pluses to help coagulates as well as cut Diathermy burns - Causes © Older earth-referenced machine = These are from ECG electrodes, metal drip stands or metal components of the operating table in contact with the patient's skin. * They provide other earths for the diathermy machine and, as their surface area is relatively small, current density may be high and severe burns will result, = Modern machines get around this problem by not needing an earth © Incorrect placement of patient plate (most common cause_ * Needs good contact with dry, shaven skin * Contact surface >70cm2 (minimal heating) * Plate must be away from body prominences and tissue with poor blood supply © Careless technique = Failure to replace electrode in insulated quiver after use © Use of diathermy on large bowel = Methane and hydrogen in large bowel can be explosive © Use close to metallic implants (eg: hip prostheses) * Current can be induced locally around metal implants ©. Causing local heating and tissue damage © Active electrode no in view of laparoscopy © Metal laparoscopic port used with plastic insulator cuffs ~ Diathermy and pacemaker ©. There are two potential problems: 1. High frequency of the diathermy may result in induced currents in the pacemaker circuits, resulting in potentially fatal arrhythmias. 2. Diathermy close to the box itself may result in currents travelling down the pacemaker wires, leading to myocardial burns. - Thus, for any patients with a pacemaker: = Discuss the case first with a cardiologist - type of box, type of pacing, underlying arrhythmia, etc. * Avoid diathermy completely if possible - if not, consider bipolar * If monopolar must be used, use only for short bursts and correct place the patient's plate so that the current flows away from the pacemaker system. If any arrhythmias are noted, stop all diathermy immediately. ~ Diathermy surgical smoke - 95% steam - 5% cellular debris - Mean diameter 0.07 ym ~ Variety of toxic mutagenic chemicals including hydrogen cyanide and benzene Diathermy ©. Diathermy is the use of high frequency electric current to produce heat Used to either cut or destroy tissue or to produce coagulation Mains electricity is 50 Hz and produces intense muscle and nerve activation Electrical frequency used by diathermy is in the range of 300 kHz to 3 MHz Patients body forms part of the electrical circuit Current has no effect on muscles 20000 Monopolar diathermy © Electrical plate is placed on patient and acts as indifferent electrode Current passes between instrument and indifferent electrode As surface area of instrument is an order of magnitude less than that of the plate Localised heating is produced at tip of instrument Minimal heating effect produced at indifferent electrode 20000 Bipolar diathermy © Two electrodes are combined in the instrument (e.g. forceps) © Current passes between tips and not through patient Effects of diathermy ©. The effects of diathermy depends on the current intensity and wave-form used © Coagulation © Produced by interrupted pulses of current (50-100 per second) © Square wave-form © Cutting © Produced by continuous current ©. Sinus wave-form Risk and complications Can interfere with pacemaker function Arcing can occur with metal instruments and implants Superficial burns if use spirit based skin preparation Diathermy burns under indifferent electrode if plate improperly applied Channeling effects if used on viscus with narrow pedicle (e.g. penis or testis) 200000 Problems with diathermy 1. More tissue is necrosed than when a tie is used. 2. Danger of explosion with volatile anaesthetics eg ether, cyclopropane 3. Danger of interaction with pacemakers a. The ideal policy is to get a cardiologist involved in patients who have a pacemaker and need surgery b. Bipolar diathermy should be used if possible. 4, Diathermy smoke has been shown to be mutagenic 5. Diathermy smoke may contain viruses including HIV although one study has shown that viable cells are not released in the smoke Precautions 1. Make sure the patient is not in contact with bare metal. 2. Always use a sheath to hold the diathermy when not in use to prevent inadvertent burning. There should be one dedicated sheath for the diathermy (burns have occurred when a metal sucker is in the same sheath, and current has then been conducted to a metal towel clip).. 3. Do not use alcohol based preps 4, Avoid electric blankets as these may provide earthing at diathermy frequencies even when not switched on (and thus lead to burns). 5. If monopolar and bipolar diathermy is being used simultaneously, the two cords should be kept. problems with capacitance.