O uso seguro de eletrocirurgia / The safe use of eletrosurgery

Objetivo: identificar os requisitos necessários para a construção de um checklist voltado para a segurança em eletrocirurgia. Método: trata-se de um estudo quantitativo, descritivo, para a produção tecnológica, a ser desenvolvida em duas etapas. Identificar-se-ão, na primeira, os requisitos necessários, por meio de revisão integrativa, para o apoio ao processo de Enfermagem (cuidados de Enfermagem) em paciente submetidos a procedimentos cirúrgicos com o uso de eletrocirurgia. Desenvolver-se-á, na segunda etapa, um checklist de apoio ao processo de Enfermagem a partir dos requisitos identificados e eleitos na etapa anterior. Resultados esperados: pretende-se disponibilizar um checklist que sirva de ferramenta para o uso seguro do bisturi elétrico, assim como contribuir para a melhoria da qualidade da assistência de Enfermagem e, ainda, diminuir o número de injúrias causadas pelo mau uso desta tecnologia.(AU)

Objective: to identify the necessary requirements for the construction of a checklist for safety in electrosurgery. Method: this is a quantitative, descriptive study for technological production, to be developed in two stages. The first one will identify the necessary requirements, through an integrative review, to support the nursing process (nursing care) in a patient undergoing surgical procedures with the use of electrosurgery. A checklist of support to the Nursing process will be developed in the second stage, based on the requirements identified and elected in the previous stage. Expected results: it is intended to provide a checklist that serves as a tool for the safe use of the electric scalpel, as well as to contribute to the improvement of the quality of Nursing care and also to reduce the number of injuries caused by the misuse of this technology. (AU)

Objetivo: identificar los requisitos necesarios para la construcción de un checklist orientado a la seguridad en electrocirugía. Método: se trata de un estudio cuantitativo, descriptivo, para la producción tecnológica, que se desarrollará en dos etapas. Se identificará, en la primera, los requisitos necesarios, por medio de revisión integrativa, para el apoyo al proceso de Enfermería (cuidados de Enfermería) en paciente sometidos a procedimientos quirúrgicos con el uso de electrocirugía. Se desarrollará, en la segunda etapa, un checklist de apoyo al proceso de Enfermería a partir de los requisitos identificados y elegidos en la etapa anterior. Resultados esperados: se pretende disponer un checklist que sirva de herramienta para el uso seguro del bisturí eléctrico, así como contribuir a la mejora de la calidad de la asistencia de Enfermería y, además, disminuir el número de injurias causadas por el mal uso de esta tecnología.(AU)

Protocolo de cuidados no uso de eletrocirurgia monopolar

A eletrocirurgia é uma prática vivenciada rotineiramente no Centro Cirúrgico. Entretanto, apesar da redução de riscos com o avanço tecnológico, as queimaduraas elétricas consistem em lesões que podem acometer o paciente no intra-operatório. A utilização de eletrocirurgia monopolar implica no uso do eletrodo dispersivo, dispositivo que fica em contato direto com a pele do paciente. Este estudo teve como objetivo elaborar um protocolo de cuidados para utilização da eletrocirurgia monopolar...

Surgical smoke evacuation guidelines: compliance among perioperative nurses.

More than 500,000 health care workers are exposed to surgical smoke every year. Toxic gases create an offensive odor, small particulate matter causes respiratory complications, and pathogens may be transmitted in the surgical smoke to the surgical team. Previous research notes that perioperative nurses do not consistently follow smoke evacuation recommendations. The purpose of this study was to determine key indicators that are associated with compliance with smoke evacuation recommendations. Data from a web-based survey completed by 777 nurse members of AORN were analyzed to examine the relationship between the key indicators and compliance with smoke evacuation recommendations. Major findings were that specific key indicators influencing compliance include increased knowledge and training, positive perceptions about the complexity of the recommendations, and increased specialization, interconnectedness, and leadership support in larger facilities. Education programs can be developed that directly address these key predictors so that a surgical environment free from surgical smoke is promoted.

[Nursing care in the use of electrosurgery]. / Os cuidados de enfermagem no uso da eletrocirurgia.

Electrosurgery is a largely used technology in surgical wards. The implementation of evidence-based practice has become essential to nurses' decision making and was chosen as the adopted theoretical-methodological framework. The present integrative literature review aimed to search for and evaluate the scientific knowledge produced on nursing care related to the use of electrosurgery in the intraoperative period. Articles were selected using the databases MEDLINE and CINAHL, and 21 articles composed the sample. Results indicate that it is imperative for perioperative nurses to have the technical-scientific knowledge about the use of electrosurgery. Found evidences support the implementation of policies and procedures that assure the safety of patients, minimizing potential risks in the use of this technology.

Electrosurgical burns in pediatric patients undergoing liver resection with saline-enhanced radiofrequency technology.

Use of saline-enhanced radiofrequency (RF) technology reduces blood loss in infants undergoing liver resection. Radiofrequency systems continuously deliver much higher currents for longer periods of time than conventional coagulation instruments and thus increase the risk of complications. Thress infants undergoing liver resection with the newer RF technology at one facility experienced electrosurgical unit (ESU) dispersive pad burns. As a result, an experiment was performed on animal subjects to determine best ESU dispersive pad placement on infants and to gather data on device impedance. Recommendations to prevent burns include central placement of the ESU dispersive pad and activating warming devices only after resection is complete.

Endometrial ablation as an alternative to hysterectomy.

In the United States, as many as two million women (ie, 22%) each year will consult a physician about menorrhagia (ie, excessive menstrual bleeding). Seven hundred thousand hysterectomies are performed in the United States each year for symptomatic menorrhagia. The procedure cost, risk, and complications, combined with the fact that a large number of posthysterectomy specimens show no abnormality, suggest that the majority of hysterectomies performed for menorrhagia are unnecessary. These data suggest that a less invasive procedure that destroys the endometrial lining but preserves the uterus would be a beneficial procedure for patients with excessive uterine bleeding. Treatment for menorrhagia may include hormone therapy, endometrial curettage, endometrial ablation, and hysterectomy. Women who are opposed to hysterectomy and those for whom other treatment options were unsuccessful can consider ablation rather than hysterectomy.

Electrosurgery in perioperative practice.

No series looking at basics in the perioperative environment would be complete without a good look at electrosurgery. And who better to inform us than Paul Wicker, who gives us all the information and advice we need to maintain patient and staff safety whilst this potentially dangerous but essential apparatus is in use. Paul also answers some of the most common questions about diathermy and its use, and I have certainly been asked all of these myself over the past couple of years. Thanks, Paul.

A national study of perioperative nurse education in two technologies.

In this study, perioperative RNs (n = 122) from hospitals throughout the United States were surveyed to explore how and what they initially learned about the different types of technology they use in direct patient care and the consequences of using these technologies. The study revealed that the most frequently identified method participants used to learn technologies (i.e., count procedure, electrosurgical unit [ESU]) was via instruction from other staff members, and RNs were more likely to learn more facts about the count procedure than about the ESU. Although the count procedure was significantly more likely to cause stress to RNs (P = .000), an inaccurate count procedure was no more likely to result in patient harm than incorrect operation of an ESU.

Electrovaporization of the prostate: initial experiences and nursing management.

UNLABELLED: STUDY DESCRIPTION: Electrocautery power is increasingly used to destroy prostatic tissue as well as to control bleeding during transurethral surgery for benign prostatic hyperplasia. This study summarizes our initial experiences with the electrovaporization procedure and combines these with the published findings of others in order to provide recommendations for the nursing management of this increasingly common urologic surgical procedure. METHODS: A retrospective review of 36 consecutive patients managed by electrovaporization of the prostate was completed. A standardized data collection form was used to evaluate the preoperative preparation, intraoperative experiences, and short-term postoperative responses to the electrovaporization procedure. These data were combined with the published experiences of others in order to provide initial insights into the nursing management of patients undergoing this procedure. RESULTS: Patient preparation was similar to that used for transurethral resection of the prostate. No patients experienced significant intraoperative bleeding. Two subjects (7%) experienced significant but transient hematuria in the postoperative period. Five men (17%) experienced urinary retention requiring catheterization, of these three were caused by blood clots and two were attributable to pre-existing detrusor muscle weakness. Urinary tract infection occurred in eight patients (27%), three of which were accompanied by a fever. All patients reported urethral and suprapubic pain following the procedure. One subject experienced flank pain caused by an acute obstruction of a solitary ureter, and one reported bladder spasms. Significant pain requiring analgesia resolved within 5 days of the procedure in all cases. CONCLUSIONS: The preoperative nursing management of the patient undergoing electrovaporization of prostate tissue is similar to that for transurethral resection of the prostate with the exception of patient teaching. Patient education should emphasize self-assessment for urinary retention, hematuria, and urinary tract infection. The postprocedural care initially focuses on monitoring the patient for catheter patency, hematuria, and infection. Patients and significant others should be warned that delayed hematuria and urinary retention may occur days or weeks after electrovaporization of the prostate. During the past decade, the number of alternative procedures for prostate tissue destruction has grown significantly. Each of these procedures offers potential advantages when compared to the classic transurethral resection of the prostate (TURP). While their usefulness in treating obstruction due to benign prostate enlargement has been reasonably well described (McCullough, 1998), the nursing management of patients undergoing many of these procedures has not been adequately studied or described. The purpose of this study was to summarize our initial experiences with the VaporTrode procedure and to better define the nursing management of patients undergoing this increasingly common urologic surgery.

Electrosurgical safety.

Technological advances in safety and the performance of electrosurgical units (ESUs) have made the ESU the most common piece of electrical equipment in the OR. The constant presence of the ESU in the OR increases the potential for patient injury that is associated with the use of any piece of electrical equipment. To prevent injuries related to the use of an ESU, the perioperative nurse must understand the types of current used, types of ESUs available, and potential complications and have a working knowledge of safe practices for using this equipment in the perioperative setting.

Minimizing patient risk during laparoscopic electrosurgery.

By the year 2000, many surgical procedures will be performed laparoscopically. When used appropriately, this technique is less disruptive to tissues than open surgery. It results in faster patient recovery time with less pain, fewer wound complications, and less scarring. As this technology is increasing, it is important to develop and implement perioperative safety precautions to reduce the risks associated with laparoscopic electrosurgery. Using the safety precautions outlined in this article may substantially reduce iatrogenic complications that can occur with these surgeries and result in better patient outcomes.

Laparoscopic electrosurgical complications and their prevention.

Insulation failures, direct coupling, and capacitive coupling around active electrodes may cause serious burns and tissue damage to patients undergoing laparoscopic procedures. A coordinated team effort between perioperative nurses and surgeons can prevent life-threatening complications from laparoscopic electrosurgical procedures. Knowledge of the biophysics of electrosurgery, the mechanisms of electrosurgery complications, and prevention of patient injuries will empower surgical team members to provide quality outcomes for patients undergoing laparoscopic procedures.