subject: Understanding Active Electrode Tools [print this page] The pencil-like handheld device can be controlled by pushing the button directly on the device or by activating the accompanying foot pedal.The pencil has two modes that can be selected on the generator, cut, and coagulation modes.
For added diversity to meet the needs of medical professionals, the pencil pieces can be purchased as a disposable or reusable tool.The economically concerned will most likely prefer the benefits of a reusable device that can be sterilized for each procedure.
The electrosurgical pencil should be used in such a way that most reduces the risk of injury to a surgical patient.Each pencil should be thoroughly inspected before use on a patient.
Injury can occur to the patient from accidental activation, incomplete circuitry, or incompatibility of the generator and the pencil hand piece.To reduce the chances of unintentional activation, place the device in a safety holster when it is not being used.
There are three different types of tips available for the electrosurgical pencil.These include the ball, blade, and needle point.
The size and shape of the tip affects how high the density of the current will be.The current sent to the tissue from the point of the active electrode gives a high electron flow over a small area.
As resistance occurs at this area, heat is produced.Because of the small area of concentration at the tip of the needle, it requires a lower power setting to cut/coagulate tissue.
When pencil hand piece tips are made from stainless steel, they are put at a disadvantage of eschar buildup that results in an increase in resistance.This can become a fire hazard because the eschar may ignite.
Stainless steel points have to be cleaned frequently with a scratch pad.Unfortunately, this causes even more eschar buildup because the scratching of eschar roughens the surface of the electrode.
All of these factors add up to time and frustration before and after every procedure.Coating the stainless steel tips with polytetrafluoroethylene makes them eschar resistant and easy to clean during and after surgical procedures.
Benefits of this coating include resistance to eschar, easily cleanable, non-stick properties, bendable, more durability, and decreased thermal necrosis.Some manufacturers have used silicone as a coating for the electrode tips, but silicone is less tolerant than polytetrafluoroethylene to high temperatures.
Polytetrafluoroethylene is a polymer surface that is lubricious and minimizes the adherence of other molecules.This allows the point to slide through tissue easily without buildup.
There are also specialty tips.The Large Loop Excision of the Transformation Zone electrodes come in several different sizes for precise excisions.
There are the bayonet needle and the blunt needle electrode.The bayonet tip allows the surgeon to have improved visibility past the pen to the site of operation.
The blunt tip reduces the risk of vessel or nerve puncture injuries, and has the benefit of a needle-like current concentration.There are also extremely sharp needles that can create current densities that are very high.
High densities allow the doctor to minimize thermal damage to tissue by using lower power settings on the generator.Active electrodes should not be modified.
Doing any modifications can put the patient at risk.For instance, some nurses or doctors have put rubber catheters on the points in an attempt to minimize the risk of secondary burns to the tissue.
The rubber catheter only increases the risks of a fire starting at the surgical site.The high temperatures of the device can ignite the rubber,and sparks and stray current can escape at the site where the rubber meets the tip.
There are three specific problems that can be related to laparoscopic monopolar electrosurgery procedures.These include direct coupling, insulation failure, and capacitive coupling.
When the active electrode touches another metal instrument, direct coupling occurs.This causes the electric current to flow from one metal surface to the other, which then causes tissue burning.
