SAFE USE OF

DIATHERMY

• RACHEAL AFOLABI, RN, RM, H. Dip.

PERI-OPERATIVE NURSING, H.Dip.
HEALTH SYSTEM MANAGEMENT
 Diathermy is one of the
most commonly used tool in
the operating theatre
 DEFINITION
• Diathermy is the generation of heat in
body tissues by means of radiofrequency
energy (passage of an electric current
through the tissues). The energy is used
to cut tissues, seal blood vessels and
destroy unwanted cells by the deliberate
application of intense heat.
Two basic patient circuits
are used
• Monopolar
• Bipolar
 MONOPOLAR
• During monopolar diathermy the patient
forms part of the electrical circuit, only
one side of the generator output is
connected to the active electrode. The
other side is connected to a large patient
return plate. The plate provides a safe
path for the current to pass back to the
diathermy.
Completed
Circuit
 BIPOLAR
• During bipolar diathermy the current flows
between the tips of the forceps, one tip
acting as an active electrode and the other
as a return. The patient’s tissue acts as
the conducting medium, through which the
current will flow. One advantage with this
type is that production of the cutting
current is virtually impossible. The field of
coagulation is limited to the contact area;
 BIPOLAR (Cont.)

• the surrounding tissues are not

damaged. There is no patient plate
attached.
EFFECTS OF SURGICAL
DIATHERMY

• CUTTING
• COAGULATION/DESICCATION
• FULGURATION
PATIENT PLATE/RETURN
ELECTRODE
• A minimum
conductive area of
10 sq inches is
recommended.
Plate must be kept
in secure contact
with the patient’s
body surface.
 SETTINGS ON ELECTRO-
SURGICAL UNIT
• Blends setting
• Autocut
• Autocoag
• Users must ensure
that they are
familiar with all
settings and their
functions
TYPES OF PATIENT
PLATES

• REUSABLE
• DISPOSABLE
 DISPOSABLE PLATES
• CONDUCTIVE ADHESIVE PLATES
- Generally thin, lightweight & flexible
- Conductive adhesive which works like gel
- Continuous adhesive border
 ROUTINE DAILY
THEATRE CHECK
• This must include checking the electro-
surgical unit to ensure that:

- All cables & electrodes insulation are intact

- Adequate supply of patient plates
- Functioning alarm systems
- Connections are all fitting securely
- Foot pedals are all present & working
THINK SAFETY!!!
 POINTS TO REMEMBER IN
PROPER PATIENT PLATE USE
• Ensure regular, planned preventative
maintenance checks
• Any faulty equipment must be removed
immediately
• Plates are single use
• Avoid placement near scars, implant sites
or ECG electrodes
• A muscular well vascularised area is most
suitable
 POINTS (Cont.)
• Site must be clean, dry & shaved
• Protect skin integrity by ensuring pt is not
resting on dispersive plate clamp
• The diathermy setting is determined by
the surgeon
• Be familiar with normal power settings
• Do not allow fluid to pool at dispersive site
• Check pt contact & connection before
commencing
 POINTS (Cont.)
• Ensure pt is not in contact with any metal
• Place active electrode in a quiver when not
in use
• Only aqueous fluids should be used for
irrigation
• On completion of procedure, remove the
plate carefully & inspect the skin
• Document use of diathermy in pt’s record
 SUGGESTED SITES FOR
PLATE PLACEMENT
• CALF
• UPPER ARM
• ABDOMEN
• MID BACK
• BUTTOCKS
• ANTERIOR & POSTERIOR THIGH
THINK SAFETY!!!
Pad Site Burn

AORN Journal, March 1991

 HAZARDS OF ELECTRO-
SURGERY
• ACCIDENTAL BURNS
• SURGICAL SMOKE
• MINIMAL ACCESS SURGERY
• ENDOSCOPIC SURGERY
 CAUSES OF THERMOELECTRIC
BURNS

• Poor patient plate contact

• Hair at the site of return electrode plate
• Break in the wire connecting the plate to
the electro-surgical unit
• Detached return cable
• Ignition of flammable material on pt’s skin
• High voltage electrocution of the pt
• Abnormally high power setting
 References
• 3M Health Care (2000) Safety in
Surgical Diathermy 3M Health Care
Ltd., England
• Wicker, P. (2000) Electrosurgery in
perioperative practice. British
Journal of Perioperative Nursing. Vol
10 (4).
 Cont…..
• Electrosurgical Safety Guide,
ConMed Corporation, USA.
THANK YOU FOR
LISTENING