Understanding The Components Of Electrosurgery
The two basic types of electrical circuits are monopolar and bipolar.Monopolar is
an electrosurgical technique in which the tissue effect takes place at a single active electrode.
The electrical current is then dispersed by a patient return electrode.The return pad must have a large contact over the conductive tissue to provide a low current density.
Failure to have a large pad or adequate technology that ensures patient safety could cause injury to the individual.Bipolar is an electrosurgery technique in which the electrosurgical effect takes place between paired electrodes placed across the tissue to be treated.
For this process, a patient return electrode is not necessary.Bipolar forceps are most often used for this particular technique.
Both electrodes are adjacent to one another, so the distance between the two is very small.The flows of the electricity are confined to the area between the active and return electrodes.
The tissue is dehydrated and resistance increases as the current passes through the tissue and from one electrode to another.As the resistance at the tissue increases, the flow of the current decreases.
The heating of tissue is caused by the electric circuit sent from the generator to the pencil.The temperature increase in the tissue is proportional to the resistance of the tissue, the density of the current, the power output, and the time of the circuit application.
If a substance is an excellent conductor it will allow easy passage of current and offer very little resistance.Because of this, the heat generated will be very low.
The amount of resistance evident in circuit flows in living tissues is inversely proportional to the amount of water present.The more water there is the lower the resistance will be and the greater the current flow through the tissue.
The current flow is greatest in tissues of high water content, like muscle. The energy flow is lowest in areas of low water content, like bone.
The order of resistance to electrical circuits goes from blood, then nerve, then muscle, then adipose tissue, and lastly bone.Surgeons are able to create a variety of different tissue responses and results with the pencil tool thanks to technological advances in manipulating waveforms.
One tissue response is desiccation, which is a direct energy application.This slowly drives water out of the cells and dries them out.
Desiccation can happen with either the cutting or the coagulation current made by touching the electrosurgical device to the tissue.Another form of tissue response is fulguration.
Fulguration is a form of coagulation that chars the surface with a spark of energy to the tissue.When the spark hits the tissue, its current density is high, making the response superficial.
This needs a high voltage that produces sparks with a coagulation effect instead of a cutting effect.The final tissue response is cutting.
Cutting waveforms vaporize the cellular fluid, which causes the cells to explode.This explosion of cells results in a dissection of tissue.
There are two types of electrosurgical generators, which include the ground referenced and the isolated generator.The ground referenced generator is typically older and outdated, while the isolated generator is more up-to-date with modern technological advances in the medical field.
Isolated generators typically have a return electrode contact quality monitoring system that measures the impedance between the patient's skin and the return pad. The benefit of this machine is that it significantly reduces pad site burns on patients.
These machines isolate the electricity from the ground and prohibit significant circuits from seeking alternate paths to the ground.This makes it so that the current has to return to the generator through the dispersive pad.
The one limitation of this machine is that pad burn sites can occur if the conductivity of the pad is hampered, or if only a small part of the patient's pad is in contact with the skin.Nevertheless, this technology is far more advanced that their ground referenced generator counterpart.
Ground reference generators create a circuit that passes through the patient and returns to the generator, which is connected to the ground.The drawback to this machine is that once the current hits the ground it can go anywhere.
This means that if the electric circuit misses the pad, it can hit ECG electrodes, the bed, or any other grounded object around.If the pad is forgotten or is not touching the skin of the patient, the machine will go ahead and send that electric current to the body of the patient through the active electrode.
If the patient is grounded by any other source, the current can and will go wherever it finds a path.Again, this may result in the patient having burns if the current densities are high.
by:Tommy Greene
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