THE FACTS ABOUT ELECTRICTY 1 Always seeks ground 2 Always seeks the path of least resistance Electricity always seeks the path of least resistance to ground The path is not always straight It can be compared to water running down a hill ID: 917049
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Slide1
ELECTROSURGERY IN ENDOSCOPY
Slide2THE FACTS ABOUT ELECTRICTY
1. Always seeks ground
2. Always seeks the path of least resistance
*Electricity always seeks the path of least resistance to
ground
*The path is not always straight. It can be compared to water running down a hill.
The water may take multiple pathways to reach the bottom of the hill. The path may include the endoscopic team (touching patient).
Slide3THE FACTS ABOUT ELECTRICTY
54-880 MHz
60
Hz
100 kHz
350kHz-3MHz
ESU’s
550-1550 kHz
Household
AM Radio
TV
*NMS still occurs in small percentage of procedure…demodulation
Slide4COMMON USES IN ENDO
Polypectomy
Papillotomy/Sphincterotomy (ERCP)
Endoscopic Mucosal Resection (EMR)
Contact Bleeding Control (Tamponade)Non-Contact Bleeding Control (APC)
Ablation (APC)
Slide5COMMON USES IN ENDO
monopolar
electrosurgery
bipolar
electrosurgery
Slide6COMMON USES IN ENDO
*The smaller the active electrode, the more concentrated the energy
*The grounding pad is a neutral electrode dispersing the energy over a larger surface area
*That is why proper grounding pad placement is so important
Slide7IMPORTANCE OF GROUNDING
Slide8UNDERSTANDING DISPERSIVE ELECTRODES
Boney prominences
Scar tissue – including Tattoos
Skin/Scars over an implanted metal prosthesis Hairy surfaces Lotions or oils on skinThe Dispersive Electrode Should
NOT Be Placed Over:
Slide9POWER VS VOLTAGE
Regulation of Power Output
The power output is dynamically regulated within the pre-set limits.
With Power Regulation, surgical/tissue effect
is consistent (independent) of:
the cutting electrode
the direction of the cut
the tissue
New Generation Generators: control
V (I) = doses
power output= controls (
predicts)
tissue effect
Slide10CLINICAL SAFETY
Incomplete Preps or enema-only preps for Flexible Sigmoidoscopy increases
the
risk for bowel explosions.Bowel explosions can occur with ANY monopolar electrosurgery (e.g. snare, APC, hot biopsy) when combined with hydrogen and methane gases in a dirty colon.Patients should be fully prepped.
The Importance of Bowel Preps…
Slide11CLINICAL SAFETY
Avoid
activation
in close proximity of metal objects
The
active probe
should not be activated if the tip is
close to or touching metal objects
Unintended thermal injury of the surrounding tissue may
occur
Metal objects may receive unintentional damage.
Exceptions - “trimming” of migrated metal stents.
Important Considerations for Endoscopy
Slide12CLINICAL SAFETY
Observe skin touching conductive objects - IV poles, metal bed rail parts
Watch for fingers, toes, ankles, and elbows touching metal
Check for arms over bedrails and hands grasping
handrails
Separate all wires, including heart monitor wires from active cords and dispersive electrode cordsElectricity Always Seeks Ground….
Alternate Site Burns
THERAPEUTIC WAVERFORMS IN GI
Endo Cut
™
(ERBE only)
YELLOW pedal
- NO TAPPING
Mode
Setting
Hemostasis Output
Effect
Intensity of
Coag
Effect 1
Cut only
Effect 2
Minimal
Coag
i.e
Soft
Coag
Effect 3
Moderate
Coag
Effect 4
Marked
Coag
Slide14THERAPEUTIC WAVERFORMS IN GI
Endocut I & Q
ENDOCUT
is a proprietary cutting output that can be very effectively used in polypectomy and papillotomy.
ENDOCUT
measures resistance variables 1000 times per second via feedback between target tissue electrode and return electrode (grounding pad). Variables would include amount of wire in contact with tissue (i.e., amount of tissue being resected every millisecond), tissue resistance (
i.e
, fibrous versus vascular), pressure exerted on snare, etc.
Cut Effect
Cut
Interval
Cut Duration
ENDOCUT
Effect
–
Level of hemostasis for bleed
control.
ENDOCUT Cut Duration
– the
length of
the cutting phase.
The
higher the
value
, the longer the cutting
phase lasts
.
ENDOCUT Cut Interval
– the
cut &
coag
cycle.
The lower the
number
, the faster the cut. Longer cut intervals results in slower, more controlled cutsOnce set, the Cut Duration and Cut Interval may not alwaysbe displayed on the screen.
Slide15ARGON PLASMA COAGULATION (APC)
APC is a non-contact monopolar application
for
hemostasis and thermal destruction
Slide16ARGON PLASMA COAGULATION (APC)
Slide17ARGON PLASMA COAGULATION (APC)
Slide18ARGON PLASMA COAGULATION (APC)
Slide19ERBE Electrosurgery &
Interventional Endoscopy
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