Electrosurgical units operate between 200 kiloHz and 3.3 megaHz.
Risk factors for injury:
(1) poor or improper grounding
(2) poor or defective insulation
(3) excessive power to the unit
(4) accidental contact to tissue or metal (coupling)
(5) failure to visualize the tip at all times
(6) inappropriate use
(7) creation of a capacitor (with a nonconductive layer sandwiched between 2 conductors)
(8) creation of an alternative conductive pathway
(9) presence of an internal electrical device or metal prosthesis
(10) buzzing a hemostat or other metal instrument held loosely with a small contact area
(11) tears in the surgeon's glove
Burns may occur:
(1) at the tip
(2) with side contact
(3) arcing
(4) along the pathway to an alternative ground
(5) through coupling (contact with a metal instrument)
Other complications:
(1) damage to an internal electrical device (pacemaker, ICD, other)
(2) damage to internal wires
(3) tissue injury at a metallic orthopedic implant
Safety measures:
(1) Regularly inspect the insulation and repair if defective.
(2) Make sure the patient is well-grounded, taking into account any devices or implants.
(3) Place the electrode in its holster when not in use
(4) Clean the tip frequently
(5) Use the lowest setting whenever possible.
Avoid:
(1) exceeding the recommended power settings
(2) leaving an open circuit
(3) using a trocar with a nonconductive element
(4) creating small contact areas
(5) creating an alternate pathways
