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Safety should be paramount when it comes to cautery pad use. In medical procedures, neglecting safety measures can lead to undesirable outcomes and patient harm, understanding and implementing proper safety protocols are essential for healthcare providers.
This blog post will explore the potential risks involved in cautery pad use and provide comprehensive guidance on how to mitigate them effectively. From burns to infection risks and more, we will cover each aspect to ensure a safe and secure environment for both healthcare professionals and patients.
Let’s dive into the world of cautery pad safety and learn how to avoid risks while maximizing positive outcomes.
Understanding Cautery Pads:
What are cautery pads?
Cautery pads are essential medical devices used in electrosurgery procedures, as an accessory of Monopolar Cautery Pencil, to control bleeding, seal blood vessels, and cut tissues. These pads are typically made of heat-conducting materials, such as metal, foam or fabric, allowing them to effectively deliver thermal energy to the target area.
Different types of cautery pads and their uses:
There are different types of cautery pads, each designed for specific applications. Two common types are monopolar and bipolar grounding pads. Monopolar pads are used in general surgeries, while bipolar pads are more suitable for delicate procedures like ophthalmology or dermatology.
For types of disposable grounding pads, pls ref to our previous blog post.
How do cautery pads work?
In monopolar cautery, a cautery pad works as the return electrode, it can be used to form a current loop while reducing the current density at the pad, to avoid burning the patient by continuing to heat the tissue when the current leaves the patient and returns to the high-frequency monopolar cautery pencil.
Common Risks Associated with Cautery Pad Use:
Burns and tissue damage
If the contact area between the cautery grounding pad and the patient is not large enough, the current will be concentrated in a smaller area, and the temperature of the grounding pad will rise, thus burning the patient. When the cautery pad contacting the skin area is 50cm2, the pad temperature is about 36℃; when the contact skin area drops to 25cm2, the temperature rises to 33℃. When the contact skin area drops to 13cm2, the temperature rises to 40℃. Burns can occur when the grounding pad temperature exceeds the skin temperature by 6°C.
Statistics show that 70% of the reported high-frequency electric knife burn accidents are caused by the negative plate is not connected or aging.
Using cautery pads involves electrical components, which can pose risks such as electrical shock or short circuits if the equipment is not properly grounded or maintained.
When the output power is as high as 100 to 700W, it will interfere with other electronic devices.
Adhering to electrical safety guidelines and regularly inspecting equipment are vital for mitigating electrical hazards.
Mindful of hard grounding pad
The hard grounding pad (that is, metal pad), is less safe than the soft ground pad, and should be observed carefully in use.
The advantages of disposable soft grounding pad is easy to use, good adhesive, and contains water, can increase the conductivity of the skin, but also can fill irregular skin, easy to conduct electricity, to avoid the disposable grounding pad on the patient’s burn, has been widely used, gradually replacing the traditional repeatedly used hard pad.
Precautions Before Use Cautery Pad:
- Choose a cautery pad with high water-based conductive adhesive.
- Place on the tissue rich in vascular muscle/clean, dry skin surface near the surgical site.
- Place over tourniquet.
- Avoid bulging bones/scar tissue/metal implants/hair or pressure areas and fatty tissue surfaces.
- The pad and the skin should be closely connected.
- Keep the plate flat, can not be cut and folded.
- Children and infants below 15kg should use special size cautery pad, which cannot be cut.
- Avoid wetting the plate when disinfecting and rinsing.
- When using REMTM Alarm System* to monitor the host, use a dedicated bipolar cautery pad.
Where to use Cautery Pad?
Where can not put:
- Insufficient blood vessels
- Irregular body shape
- Bony ridges, bony ridges
- Skin folds of scar tissue
- Metal implants under the skin
- More hair
- Fat tissue or fat thicker, epidermis, weight-bearing site
- Where fluid may accumulate
- Near a metal graft or pacemaker.
Where can put:
- Easy to see areas, flat muscle areas, vascular-rich areas, shaved skin, clean dry skin
- The cautery pad is more than 15cm away from the ECG electrode
- As close as possible to the surgical incision site (but not less than 15cm) to reduce the current loop, but the ideal paste site should be selected first
- Avoid current loop through metal grafts, pacemakers, electrocardiogram electrodes, heart
- The long side of the electrode pad is perpendicular to the high-frequency current.
- Select flat muscle areas such as the thigh, back or abdomen for the infant’s electrode pad;
Special tips for soft disposable grounding pad
Prohibit cutting and folding, and prevent local current from being too high or leakage.
One-time use, prohibited reuse
Because after use, the conductive adhesive on the surface of the cautery pad is attached to the dander, and after hair, its physical and chemical properties change, poor conductivity, reduced safety performance, and the possibility of burning of patients increases. After used, the cautery pad may carry bacteria, HIV, HBV and other microorganisms or skin disease patients’ dander, and the same electrode pad may cause cross-infection when used repeatedly between different patients.
Safety Measures of Cautery Pad Use
Safety measures before use
- If necessary, the hair should be shaved
- Prepare the part as required by the manufacturer
- Do not cut or fold
- Avoid skin to skin contact when placing the patient
- Use MATS made of insulated gauze, linen, etc. to separate the skin
- When placing the cautery pad, ensure that the current flows directly from the surgical site to the pad.
Safety measures when using
Recheck the cautery pad when the patient or the environment changes
- Reposition the patient
- The cautery pad conductor is suddenly tightened or pulled
- There’s fluid flowing into the cautery pad
Check below if power setting exceeds the normal level
- Whether the cautery pad is tightly pasted
- Whether the cautery pad gel is dehydrated
- Whether the electric resistance of the cautery pad is too large
Children and infants need special cautery pad
- Note recommended maximum power Settings (maximum power 150W)
- If the patient is too small for all monopolar cautery pads to be attached, consider using bipolar
Safety measures after use
Check the skin where you put it
- Is the skin intact?
- Is the skin color normal?
Use of REMTM Alarm System for Bipolar Grounding Pad
How does REMTM alarm system work?
Some brands of electrosurgical generator units are equipped with a contact quality monitoring system, and manufacturers use varying terminology when referring to their systems.
All the systems, however, monitor the quality of contact between the return electrode(cautery pad) and the patient. Consequently, if the return electrode has poor contact or conductivity, the generator is disabled, thus significantly reducing the patient’s risk for a burn at the return electrode site.
Unlike the return electrodes for a grounded system or an isolated system without a contact quality monitoring system, return electrodes for systems equipped with a contact quality monitoring system consist of a bipolar grounding pad(split plate) with a conductive adhesive surface that is dry or high in moisture content, such as a hydrogel-based adhesive that contains at least 50% water.
When will REMTM alarms?
Cautery pad area: the effective conductive area of the general children’s grounding pad is 65cm2, and the effective conductive area of the adult grounding pad is 129cm2. Once the contact area of the cautery pad is reduced and the resistance increases to an unsafe level, the machine automatically alarms and stops output.
In conclusion, safety is of utmost importance when it comes to cautery pad use. Throughout this blog post, we have explored the potential risks, precautions, and safety measures associated with this essential medical procedure, by following the best practices outlined in this blog post, healthcare providers can mitigate potential complications and It is crucial to stay informed, continuously update knowledge, and seek further training to improve skills and ensure the highest level of patient well-being.
Always remember, when it comes to cautery pad use, avoiding risks and ensuring safety should be the guiding principles. By prioritizing safety, we can achieve successful outcomes and provide optimal care to our patients.