Electrosurgery Self-Study Guide - Tyco

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Electrosurgery Self-Study GuideElectrosurgical ModeDifferentiationElectrosurgical generators can produce current in threedifferent modes, each with distinct tissue effects. Themodes are cut, fulguration and desiccation.Electrosurgical CutThe cutting current is a continuous waveform (Figure 6).duty (on/off) cycle (Figure 8). Examples of blendwaveforms from different generators are:Blend 1 = 50% on/50% offBlend 2 = 40% on/60% offBlend 3 = 25% on/75% offVariations of cut to coagulation blends may occur amongmanufacturers. Generally, however, a higher blendnumber means more coagulation.PURE CUT100% onBLEND 1 BLEND 2 BLEND 350% on50% off40% on60% off25% on75% offFigure 6 – Cut WaveformSince the delivery of current is continuous, much lowervoltages are required to achieve the desired effect oftissue vaporization. To achieve a cutting effect, the tip ofthe active electrode should be held just over the targettissue. The current vaporizes cells in such a way that aclean tissue cut is achieved (Figure 7). The cut mode ofthe generator is also a good choice for achievingcoagulation of tissue through desiccation.Figure 8 – Blended WaveformsFulgurationTissue fulguration is achieved with the coagulation modeon the generator. The coagulation mode produces aninterrupted or dampened waveform with a duty cycle thatis on about 6% of the time (Figure 9).COAG6% on94% offFigure 7 – Vaporization or CuttingBlended ModeThe blended mode on a generator is a function of the cutwaveform. Blended currents produce voltages higherthan that of the pure cut mode. The generator output ismodified to a dampened waveform that produces somehemostasis during cutting (Tucker, 1998). There areseveral blended waveforms that provide different ratios ofcoagulation with the cutting current by modifying theFigure 9 – Coagulation WaveformThe coagulation current produces spikes of voltage ashigh as 5000 volts at 50 watts. The tissue is heated whenthe waveform spikes, and cools down in between spikes,thus producing coagulation of the cell during the 94% offcycle of he waveform.8
Electrosurgery Self-Study GuideThe correct method for achieving fulguration when usingcoagulation is to hold the tip of the active electrodeslightly above the target tissue (Figure 10).Figure 10 – FulgurationDesiccationElectrosurgical desiccation can be produced using eitherthe cut or coagulation mode on the generator. Thedifference between fulguration and desiccation is thatthe tip of the active electrode must contact the targettissue in order to achieve desiccation (Figure 11). Thedesired mode to achieve tissue desiccation through directcontact is the cut waveform.CUTLow voltagewaveform100% dutycycleCOAGHigh voltagewaveform6% duty cyclePOWER – The power setting the surgeon uses will altertissue effect. The surgeon should always use the lowestsetting to achieve the desired tissue effect. The setting willdiffer from patient to patient. Muscular patients of weightand height in proper portions will require lower powersettings than obese or emaciated patients. The location ofthe return electrode in relation to the surgical site willimpact the power required to overcome the amount oftissue mass (resistance) between the two (2) sites.ELECTRODE – The size of the active electrode influencesthe tissue effect of the generator. A large electrode needsa higher power setting than a smaller one because thecurrent is dispersed over a wider surface area (Figure 12).A clean electrode will need less power to do the samework as a dirty one because eschar buildup has higherresistance and will hamper the passage of the current.Electrodes can be coated with Teflon (PTFE) or anelastomeric silicone coating to reduce eschar buildup.These coated blades wipe clean with a sponge andeliminate that need for a “scratch pad” which causesgrooves on stainless steel electrodes that may contributeto eschar build-up. These different types of blades shouldbe evaluated because some will enable the surgeon to uselower power settings, reducing the potential for thermalspread. In addition, some coated electrodes are bendable,have a non-flake coating and retain their cleaningproperties longer than other coated electrodes.decreasesCurrent Concentration & HeatincreasesLow currentconcentration(density)Electrode sizeHigh currentconcentration(density)Figure 11 – DesiccationOther Variables That Impact Tissue EffectThe electrosurgical mode that the surgeon uses has adefinite impact on patient tissue. There are other variablesthat can also alter the outcome of the electrosurgicaltissue effect:TIME – The length of time that the surgeon uses the activeelectrode determines the amount of tissue effect. Too longan activation time will produce wider and deeper tissuedamage. Too short an activation time will not produce thedesired tissue effect.increasesPower Setting RequirementdecreasesFigure 12 – Current Concentration Effect on Power SettingsTISSUE – Patient tissue can determine the effectivenessof the generator. The physical characteristics of thepatient’s body will determine the amount of impedanceencountered by the electrosurgical current as it attemptsto complete the circuit through the return electrode to thegenerator. A lean muscular patient will conduct theelectrosurgical current much better than an obese or anemaciated patient.9
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Electrosurgery Self-Study Guide - Tyco

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