电外科操作指南-培训课件.ppt

* Preoperative cardiology consult to evaluate correct functioning and determine risks Defibrillator immediately available Deactivate the ICD before ESU use. Using electrosurgery on a patient with an activated ICD may trigger an electrical shock to the patient. Continuous ECG and peripheral pulse monitoring. Use bipolar as an alternative whenever possible. If monopolar used, ensure distance between the active and patient return electrode is as short as possible. Avoid current flow through heart and ICD. AORN, Standards, Recommended Practices, and Guidelines, 2008 Edition, Denver, CO: AORN Donnelly, P.Pal, N.Herity, N.( 2007). Perioperative Management of Patients with Implantable Cardioverter Defibrillators. N.Ulster Med J. 76(2): 66–67 * Electrosurgical generators run at a radio frequency (RF) of 200 kHz to 3.3 MHz. There is always a certain amount of high and low RF leakage from all electrosurgery equipment in the market place. Therefore, there is concern about the effect of this leakage on any medical devices owned by or used on patients in surgery. Research shows that the only hearing aids that have been adversely affected by (RF) leakage have been exposed to radio frequencies much higher than electrosurgical units. The one documented event that was related to a security system that runs at a frequency of 900 MHz. Generally speaking, there are no safety dangers caused by RF leakage to hearing aids worn into surgery, as long as they do not interfere with the surgical procedure itself. However, it is recommended that a hearing is not worn during surgery when electrosurgery is used. The RF leakage will potentially cause some interference to the hearing aid reception and if the patient is awake and unable to make adjustments because of restraints, this could cause considerable irritation and/or discomfort to the patient. Such things as garage door openers, microwaves and cellular phones can also affect hearing aids. When interference does occur, the