Therapeutical Medical Equipment

Malisa F

Arusha Technical College

April 3, 2023

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EBT 06201-Therapeutical Medical Equipment

Module Name:Therapeutical Medical Equipment

Module Code: EBE 06201

Assessment methods:
Test: 15 marks
Assignment: 05 marks
Presentation: 05 marks
Lab Session: 15 marks
Final Exam: 60 marks

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ESU

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Human body characteristics and response to electrosurgical
process

Electrosurgery is the application of a high frequency electric current to

biological tissue as a means to cut, coagulate, desiccate, or
fulgurate tissue

Cautery Refer to the destruction or denaturation of tissue is achieved

by passively transferring heat from a heated instrument
(resistant metal wire)
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Human body characteristics and response to electrosurgical
process

Electrocautery refers to applications of direct current(electrons

flowing in one direction) whereas electrosurgery uses alternating
current.
During electrocautery, current does not enter the patient’s body.Only
the heated wire comes in contact with tissue.
Electrocautery Current is used to heat a handheld element, which is
then applied to the tissue
Electrosurgery Passing electrical current through tissue

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Human body characteristics and response to electrosurgical
process

The electrosurgical generator is the source of the electron flow and

voltage. The circuit is composed of the generator,active electrode,
patient and patient return electrode.
Pathways to ground are numerous but may include the Operating
Room table, stirrups, staff members and equipment.
The patient’s tissue provides the impedance, producing heat as the
electrons overcome the impedance.

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Frequency Spectrum

Standard electrical current alternates at a frequency of 50/60 cycles

per second (Hz).
Electrosurgical systems could function at this frequency, but because
current would be transmitted through body tissue at 50/60 cycles,
excessive neuromuscular stimulation and perhaps electrocution would
result.
Because nerve and muscle stimulation cease at 100,000 cycles/
second(100 kHz), electrosurgery can be performed safely at “radio”
frequencies above 100 kHz.
An electrosurgical generator takes 50/60 cycle current and increases
the frequency to over 200,000 cycles per second (200kHz to 4MHz).
At this frequency electrosurgical energy can pass through the patient
with minimal neuromuscular stimulation and no risk of electrocution

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Types of Electrosurgery techniques

Cutting (Electrotomy)
Coagulation
Fulguration
Desiccation
Haemostasis

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Principle of Surgical Diathermy -diagram

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Principle of Surgical Diathermy

High frequency currents (in Cutting the range of 1-3 MHz) can be
used in operating rooms for surgical purposes involving cutting and
coagulation.
Surgical diathermy machines depend on the heating effect of electric
current.
When high frequency current flows through the sharp edge of a wire
loop or band loop or the point of a needle into the tissue (Figure
above), there is a high concentration of current at this point.
The tissue is heated to such an extent that the cells which are
immediately under the electrode, are tom apart by the boiling of the
cell fluid.
The indifferent electrode establishes a large area contact with the
patient and the RF current is therefore, dispersed so that very little
heat is developed at this electrode.
This type of tissue separation forms the basis of electro-surgical
cutting
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Cutting

A combination of fine wire electrodes, high RF voltage and high

cutting speeds are necessary for confinement of tissue destruction in
electro-surgery.
These parameters are of great value in microsurgery since localization
of electrosurgical effects would be accompanied by coagulation and
hemostasis.
Evolving steam bubbles in the tissues at the surgical tip continuously
rupture the tissue and are responsible for the cutting mechanism

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Coagulation

Electro-surgical coagulation of tissue is caused by the high frequency

current flowing through the tissue and heating it locally so that it
coagulates from inside.
The coagulation process is accompanied by a grayish-white
discoloration of the tissue at the edge of the electrode.
In contrast to a thermocauter, better coagulation can be achieved by
high frequency currents because it does not cause superficial burning

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Fulguration

The term ’fulguration’ refers to superficial tissue destruction without

affecting deep-seated tissues.
This is undertaken by passing sparks from a needle or a ball electrode
of small diameter to the tissue.
When the electrode is held near the tissue without touching it, an
electric arc is produced, whose heat dries out the tissue.
Fulguration permits fistulas and residual cysts to be cauterized and
minor haemorrhages to be stopped.

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Dessication

In desiccation, needle-point electrodes are stuck into the tissue and

then kept steady.
Depending upon the intensity and duration of the current, a high
local increase in heat will be obtained.
The tissue changes due to drying and limited coagulation.

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Haemostasis

The concurrent use of continuous radio-frequency current for cutting

and a burst wave radio-frequency for coagulation is called
Haemostasis mode.
The cutting current usually results in bleeding at the site of incision,
whereas the surgeon would require bloodless cutting.
The machines achieve this by combining the two waveforms shown in
Figure below.
The frequency of this blended waveform is generally the same as that
used for cutting current.

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Blend

A “blended current” is not a mixture of both cutting and

coagulation current but rather a modification of the duty cycle.
As you go from Blend 1 to Blend 3 the duty cycle is progressively
reduced.
A lower duty cycle produces less heat. Consequently, Blend 1 is able
to vaporize tissue with minimal hemostasis whereas Blend 3 is less
effective at cutting but has maximum hemostasis.

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EFFECTS OF CURRENT ON TISSUE

Temperatures above 45°C cause a breakdown in the structure of living

tissue and disruption of the function of protein molecules.
The process is referred to as denaturation. The origin is a thermal
effect.
Coagulation:
Temperatures of 60 – 70°C in the area around the active electrode
lead to a slow boiling of the intra-cellular fluid through the cell
membrane.
As a result of this effect, the cell shrinks and several cells link up to
form chains. A ”welding effect” is initiated which stops the bleeding

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EFFECTS OF CURRENT ON TISSUE

Electrotomy:
Temperatures of above 100°C in the region around the active
electrode lead to the rapid evaporation of the fluid within the cell
membrane.
As a result, the cell membrane ruptures forming vapor around the
electrode which in turn involves other cells lying in the path of the
electrode as it moves.
Electrotomy thus cannot be compared to a mechanical cutting
process.

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Variables Impacting Tissue Effect

Size of the electrode:The smaller the electrode, the higher the

current concentration. Consequently,the same tissue effect can be
achieved with a smaller electrode, even though the power setting is
reduced.
Time: At any given setting, the longer the generator is activated, the
more heat is produced.
Manipulation of the electrode: This can determine whether
vaporization or coagulation occurs. This is a function of current
density and the resultant heat produced while sparking to tissue
versus holding the electrode indirect contact with tissue
Type of Tissue: Tissues vary widely in resistance.
Eschar: Eschar is relatively high in resistance to current. Keeping
electrodes clean and free of eschar will enhance performance by
maintaining lower resistance with in the surgical circuit.

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Cut waveforms generated by machines

Cut waveform generated by electron tube circuit

Cut waveform generated in a solid state diathermy machine

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Coagulate and Blend waveforms generated by machines

Coagulate waveform produced by a spark gap generator

Coagulate waveform generated in a solid state diathermy machine

Blend waveform produced in a solid state diathermy machine

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Types of ESU Unit

Monopolar technique
1

2 Bipolar technique

Mono-Polar Technique (flow of current)

Generator→ Active Electrode tip → Patient → Neural Electrode →
Generator

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Monopolar technique

Electrical energy flows from the generator (ESU unit), to the active
electrode (cautery pencil).
The energy then passes through the patient to the dispersive cautery
pad, thus completing the electrical circuit.
Bipolar Technique
Generator → Active Electrode tip → Patient → Electrode tips →
Generator

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Bipolar Technique...

Bipolar electrosurgery uses 2-tined bipolar forceps

One tine of the forceps serves as the active electrode, and the other
tine serves as the return electrode
The electrical current is confined to the tissue between the tines of
the bipolar forceps
A grounding pad is not needed for bipolar-only cases

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ESU Grounding Pads

Available in infant and adult sizes

Infant size: follow grounding pad manufacturer’s recommendation for
appropriate weight range
NEVER cut a grounding pad to fit a patient, always use the
appropriate size pad
Function of the Patient Return Electrode
A return electrode burn occurs when the heat produced, over time, is
not safely dissipated by the size or conductivity of the patient return
electrode.
(CURRENT )X (TIME )
BURN = (1)
AREA
HEAT = I 2 RT (2)
The amount of heat is determined by the electric current (I), the ohmic
resistance (R) and the duration (T) is expressed
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Dangerous Return Electrode Contact with Current
Concentration

In the case of reduced contact area, the current flow is concentrated

in a smaller area.
As the current concentration increases, the temperature at the return
electrode increases.
If the temperature at the return electrode site increases enough, a
patient burn may result.
Surface area impedance can be compromised by: excessive hair,
adipose tissue, bony prominences, fluid invasion, adhesive failure, scar
tissue, and many other variables.

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Placement of Grounding Pad

When considering grounding placement it is important to know that

electric current travels easily through muscular & vascular tissue
Electric current does not travel well through bone, scar or adipose
tissue
Best Grounding Pad Site
Over a well-vascularized muscle mass
Avoid placing grounding pad over bony prominences, hairy sites, scar
tissue,excess adipose tissue
Pad site should be free from lotions or oils
In some male patients it may be necessary to remove hair from the
desired pad site using clippers
Place grounding pad as close to the surgical site as possible
Grounding pad should be placed so that the entire surface of the pad
is in uniform contact with the pad site
Avoid any tenting or gaps where parts of the pad are not in contact
with the patient
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REGULATING THE THERMAL EFFECT

Regulating the thermal effect through:

Current and output power
Modulation level
Shape of electrode
Condition of active electrode
Cutting speed and duration of action
Tissue properties
1 MODULATION LEVEL
This is understood to mean the wave form of the high frequency current
produced by a particular generator design and instrument setting
The modulation level can for example be a parameter for the
aggressiveness of an electrical incision, but it can also be for the depth of
penetration in a coagulation procedure.

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ELECTRODE SHAPE

The designed shape of the active electrode is the final determinant for
the field concentration at the point of application.
Thin, point-shaped electrodes create a high current density and
therefore a high temperature. The result is an electric cutting effect.
Larger surface electrodes create a lower current density and thus a
lower temperature and produce a coagulation effect

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CONDITION OF THE ELECTRODE

According to Joule’s law of thermodynamics, the effects are

proportional to resistance.
In addition to the physical resistance already described, the electrode
contact resistance, i.e. an electrode on which coagulate has already
formed, increases the resistance of the system enormously

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TISSUE PROPERTIES

As has already been mentioned, physiological tissue varies in its resistance

properties.
These properties are expressed physically by the specific resistance R0

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