The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective January 1, 2004 .

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situation that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physician’s offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where surgery may be performed.

Purpose

These recommended practices provide guidance to perioperative nurses in the use and care of electrosurgical equipment.

Recommended Practice I  

Personnel selecting the electrosurgical (devices) for purchase or use should make decisions based on safety features to minimize risks to patients and personnel.

Interpretive statement 1:

• Equipment selected should include technology to detect stray current that could result in patient injury and to alert the user to this condition.
• Equipment should be designed to minimize the risk of capacitive coupling injuries.  

Interpretive statement 2:

• During minimally invasive procedures, injuries have resulted from insulation failure and capacitive coupling.
• These injuries are very serious and have increased in number with the increased use of laparoscopic surgery.

Interpretive statement 3:

• The use of active electrode monitoring has minimized these risks.  

Recommended Practice VIII

 Personnel should take special precautions when using electrosurgical devices during endoscopic procedures.

Interpretive statement 1:

• Personnel should understand the risks of electrosurgery during endoscopic procedures.
• Insulation failure of the laparoscopic electrode … can cause serious patient injury.
• Capacitively coupled current can cause undetected burns to nearby tissue … outside the viewing field.
• Serious patient injuries have resulted.

Interpretive statement 2:

• Insulation failure of electrodes … provides an alternate pathway for the current to leave the active electrode.
• Some insulation failures are not visible. This has resulted in serious patient injuries. These injuries may be outside the visual field.

Rationale

• Use of active electrode shielding and monitoring minimizes the risks of insulation failure and capacitive-coupling injuries.