EBME Forums Forums Maintenance Technical Assistance burned during surgery

any idea on what the cause of patient got burned on ground plate portion?

Thanks.

Cause of patient burn in the vicinity of ground / return plate during electrosurgery or diathermy is usually poor contact.

General guidance:
The application site must be clean, dry and shaved; excess hair is the most common cause of electrosurgical burns.
Avoid using alcohol-based skin preparation solutions.
Check the location of the return electrode in relation to the patient’s position, the operating site, scars, metal implants or metal foreign bodies.

With much improved technological design in ESU, we are seeing less of burn reported cases. The cause of burns can be due to faulty application of the return pad, which failed to have good contact with the patients' skin. When the return pad is loose, this may cause heat generation and sparking at the contact site as there is no appropriate path for the current to pass safely through the circuit. Always ensure that the patient's return pad is adequately applied with firm contact to the skin over an adequate surface area of at least 70 cm2 of firm skin-pad contact. Newer return pads with adhesive properties that firmly attach them to skin and ESU's active alarm system should address and help limit the extent of the resultant burn injury.

It's basic physics. Consider what happens (deliberately) at the active electrode. All that "pin-pointed" energy (high-density RF current) has to be safely dispersed over a relatively large area when leaving the patient (completing the circuit). In other words, low current density if any "heating effect" (burn) is to be avoided. I seem to remember at one time the "return plate" was often known as the "dispersive electrode".

But even the best "return plate" in the world won't be much good if it's not firmly in contact with the patient! It has to complete the circuit.

Yes, over the years various attempts at "return (electrode) plate monitoring" have been tried. Some have been more effective than others, but any ESU should have some sort of REM (unless, of course, it is truly ancient). And, naturally, it should be checked as part of regular I/PM!

Meanwhile, and in passing, it may be worth recalling that current will always take the path of least resistance ... so if the patient's leg is flopped against the bare metal of the table (for example), then that is where the "burns" are most likely to occur (asssuming, of course, that the table itself is earthed)!

Couple of useful links here might give you some pointers:

http://www.mddl.org.uk/mddl/emodules/ESUGenericModule/player.html
and
http://www.pfiedler.com/ce/1256/#

Good luck

Nice link. your input is highly appreciated.

but how to down load this MHRA modules.

I've got few unit's that "burned patient" in a year. And I had only one instance where actualy unit was the cause of burning. Most of burnings are because bad condition of neutral electrode( for multiple usage). I always recomend use one-time electrode. Also cause of burnings might be fluid between pad and patient.

How come?

I'm not sure about it it was long time ago, but as I remember there was a problem with electrode socked and simultaneously with cable(very bad coincidence).

Radio frequency energy is powerful stuff.