Checklist

Preoperative Precautions and Procedures

 Physical Condition

— Examine the ESU and its accessories for defects—do not use cables or accessories with damaged (cracked, burned, or taped) insulation or connectors.

— Confirm that the ESU has been inspected for safety and performance by a qualified BMET or clinical engineer and that the next inspection is not yet due.

Return Electrode Contact Quality Monitor (RECQM) or Cable Continuity Alarm

— Check the operation of the RECQM or the return electrode cable continuity alarm by attempting to operate the unit with the dispersive electrode disconnected—the unit should not activate, and a tone should sound.

Audible Activation Indicator

— Activate the unit using each footswitch and handswitch, and verify that the audible activation tone is loud enough to be heard over other noises in the OR.

— Verify operation of any other alarms or protective features.

Safety Holster

— Position a safety holster for the active electrode in a convenient location.

Dispersive Electrode

— Use a full-surface adhesive electrode.

— Inspect the electrode before placement for any flaws or damage (e.g., discoloration, insufficient amounts of conductive adhesive).

— Confirm that the electrode's expiration date has not passed.

— Clean, shave, and dry the application site.

— Follow the manufacturer's recommendations for application, and ensure firm contact of the electrode with the skin.

— Do not apply the electrode to areas where pressure is applied to the patient (e.g., underneath the patient).

— Do not overlap sections of the electrode (e.g., when applying around a small limb).

— When possible, place a long edge of the electrode closest to the surgical site.

— If possible, do not place the dispersive electrode (or active electrode) cables near internal pacemaker leads.

Alternate Sites

— Eliminate patient contact with grounded objects whenever possible.

— If possible, remove nonvital monitoring electrodes (e.g., esophageal and rectal probes).

— Keep ECG and other monitoring electrodes as far as possible from the surgical site and the active and dispersive electrode cables.

— Do not use needles as monitoring electrodes (these increase the risk of alternate site burns due to higher current density at the electrode site).

Prepping Agents

— Avoid using flammable prepping agents or other flammable fluids (e.g., acetone degreaser).

— Avoid accumulating pools of fluids, especially near patient electrodes.

Sparking the Active Electrode

— Do not spark the active electrode to ground or to the dispersive electrode to test the ESU.

Intraoperative Precautions and Procedures

— Minimize buildup of O₂ and N₂O beneath drapes and in the oropharynx.

— Activate the unit after vapors from flammable prepping solutions and tinctures (if used) have dissipated.

— Activate the unit only when ready to deliver electrosurgical current and only when the active tip is in view; avoid prolonged activation.

— Use the lowest effective ESU output setting; do not continue to increase power settings if you aren't getting results—look for other problems (e.g., confirm adequate placement of the dispersive electrode, check all cable connections).

— Check contact and adherence of the dispersive electrode each time the patient is repositioned.

— Always place the active electrode in a safety holster when not in use.

— Allow only the user of the active electrode to activate the handswitch or footswitch.

— Do not use two active electrodes on ESUs that produce simultaneous activation of both electrodes when only one switch is activated.

— Document every procedure in the OR record; include the ESU identification number, ESU settings used (monopolar cutting and coagulation, bipolar), location of the dispersive electrode, and the condition of the skin at the dispersive electrode site before and after the procedure.

— Document use and position of any other equipment (including identification numbers) used during the procedure (e.g., hypo-/hyperthermia unit, temperature probes).

Postoperative Precautions and Procedures

— Inspect the patient for injuries at the dispersive electrode and other sites (e.g., the sacral area—electrosurgical injuries typically appear immediately following the procedure; pressure injuries may not show up for as long as one or two days following surgery).

— Document all findings.

— If any problems are noted during or after the procedure, save all disposable items and their packages (so that expiration dates can be confirmed).