Clarification on "Clinical Issues" answer on return electrodes

AORN Journal,  July, 2005  by Mark L. Phippen,  Sharon Giarrizzo-Wilson

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PATIENT RETURN ELECTRODES

I want to respond to the Clinical Issues question concerning the proper application of the electrosurgical patient return electrode (February 2005, vol 81, no 2, page 399). I am concerned that the response did not mention following the manufacturer's instructions for use (IFU). The response provided appears to be based on the IFU for a particular manufacture of patient return electrodes. It was not, however, the correct response for all electrosurgical manufactures.

As an example, for those using a Valleylab return electrode monitoring (REM) system and a Valleylab Force FX-C electrosurgical generator, the manufacturer recommends applying two patient return electrodes only when the REM system alarm cannot be satisfied. Also, the Valleylab IFU does not limit the location of placement for the second patient return electrode application site. Potential sites for placement of a second patient return electrode are the patient's thigh, upper biceps, call and lower back. Additionally, if two patient return electrodes are applied to the same extremity, such as a thigh, they should be applied to the anterior and posterior surfaces of the thigh or to the lateral and medial surface, not side-by-side. Furthermore, the patient return electrodes should not be applied circumferentially on the extremity. Perioperative nurses should contact their electrosurgery generator manufacturer concerning specific instructions for the use of two patient return electrodes.

MARK L. PHIPPEN

RN, MN, CNOR

DIRECTOR OF PROFESSIONAL EDUCATION

AND CLINICAL SUPPORT

TYCO HEALTHCARE VALLEYLAB

BOULDER, COLO

Author's response. Thank you for your comments regarding the Clinical Issues column. AORN does not endorse any vendor products, so a generic answer was posted to address the issue of appropriate use for dual return electrode systems. ECRI, formerly the Emergency Care Research Institute and a well-known nonprofit health services research agency, continues to support the use of a second parallel return electrode when a single dispersive pad cannot accommodate electrical current flow due to resistance (eg, impedance). (1,2) This information is specific to the generation of the electrosurgical unit (ESU) being used and the type of dispersive electrode employed. Perioperative nurses must be familiar with the appropriate operation of products used for patient care and the manufacturer's guidelines for specific applications. There are multiple technologies available for electrosurgical interventions, so it is important for perioperative nurses to possess current knowledge of ESU functionality and compatibility guidelines for off brand use of dispersive electrode technology. Additionally, ESU manufacturers' recommendations for special applications and additional equipment or adaptors are required to ensure patient safety.

SHARON GIARRIZZO-WILSON

RN, MS, CNOR

PERIOPERATIVE NURSING SPECIALIST

CENTER FOR NURSING PRACTICE

(1.) ECRI, "ESU burns from poor return electrode site preparation," Health Devices 16 (January 1987) 35-36. Also available at http://www.mdsr.ecri.org/summary/detaiL.aspx? doc_id=8188&q=esu (accessed 6 Dec 2004).

(2.) ECRI, "ESU burns from poor dispersive electrode site preparation," Health Devices 22 (August/ September 1993) 422-423. Also available at http://www.mdsr.ecri .org/summary/detail.aspx?doc_id=8 204&q=esu (accessed 18 May 2005).

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