AORN Electrosurgical Safety 2 — Questions and Answers
Question 1: What distinguishes bipolar electrosurgery from monopolar electrosurgery?
- Bipolar uses higher voltage to achieve faster tissue cutting
- In bipolar electrosurgery, current travels only between the two tips of the instrument, eliminating need for a dispersive electrode (Correct answer)
- Bipolar electrosurgery uses a separate dispersive electrode on each limb
- Bipolar mode generates a continuous waveform while monopolar uses interrupted pulses
Correct answer: In bipolar electrosurgery, current travels only between the two tips of the instrument, eliminating need for a dispersive electrode
In bipolar electrosurgery, current passes only between the two tips of the forceps, confining the electrical effect to a very small area and eliminating the need for a dispersive electrode.
Question 2: What is 'capacitive coupling' in the context of laparoscopic electrosurgery?
- Transfer of electrical energy through direct contact between two conductive instruments
- Generation of an electrical charge in a nearby conductor without direct contact via an insulated active electrode (Correct answer)
- Shorting of the active electrode against the trocar sleeve
- Failure of the return electrode to maintain adequate skin contact
Correct answer: Generation of an electrical charge in a nearby conductor without direct contact via an insulated active electrode
Capacitive coupling occurs when electrical energy is transferred from the insulated active electrode to a nearby conductor (e.g., a metal trocar) without direct contact, potentially causing unintended tissue burns.
Question 3: What is 'direct coupling' in laparoscopic electrosurgery, and why is it dangerous?
- The ESU is directly connected to the return electrode, bypassing safety circuits
- The active electrode accidentally makes contact with another metal instrument, conducting current to unintended tissue (Correct answer)
- Current travels directly through the trocar without tissue contact
- Two monopolar instruments are used simultaneously, doubling the electrical output
Correct answer: The active electrode accidentally makes contact with another metal instrument, conducting current to unintended tissue
Direct coupling occurs when the energized active electrode touches another metal instrument inside the body cavity, transferring current to that instrument and potentially burning adjacent tissue outside the surgeon's view.
Question 4: According to AORN standards, what is the recommended power setting principle for electrosurgical units?
- Use the highest setting to minimize activation time
- Use the lowest effective power setting that achieves the desired tissue effect (Correct answer)
- Set power to a standard facility preset regardless of tissue type
- Increase power by 10% increments until hemostasis is achieved
Correct answer: Use the lowest effective power setting that achieves the desired tissue effect
AORN recommends using the lowest effective power setting to achieve the desired surgical effect, reducing risks of burns, smoke plume, and unintended tissue damage.
Question 5: Before applying the dispersive electrode, what patient assessment should the perioperative nurse perform?
- Assess the patient's allergy history and inspect the intended placement site for hair, scar tissue, bony prominences, or compromised skin integrity (Correct answer)
- Measure the patient's body temperature to ensure adequate perfusion
- Verify that the patient has not eaten within 8 hours prior to surgery
- Check the patient's blood pressure and heart rate for hemodynamic stability
Correct answer: Assess the patient's allergy history and inspect the intended placement site for hair, scar tissue, bony prominences, or compromised skin integrity
The perioperative nurse must inspect the dispersive electrode placement site for conditions (hair, scars, bony prominences, skin breakdown) that reduce contact area or conductivity and increase burn risk.
Question 6: What does the Return Electrode Monitoring (REM) system do during electrosurgical procedures?
- Monitors the frequency output of the ESU generator continuously
- Detects changes in impedance at the dispersive electrode and alarms when contact is inadequate (Correct answer)
- Records the total energy delivered during the surgical case
- Prevents the ESU from activating unless the dispersive electrode is applied
Correct answer: Detects changes in impedance at the dispersive electrode and alarms when contact is inadequate
The REM system continuously measures impedance at the dispersive electrode site and triggers an alarm if contact becomes inadequate, preventing burn injury before it occurs.
Question 7: Why should pooling of prep solutions under the patient be prevented before electrosurgery is used?
- Pooled solution increases electrical resistance and reduces cutting efficiency
- Pooled flammable or caustic solution can ignite or cause chemical burns when exposed to ESU activation (Correct answer)
- Pooled solution conducts current away from the surgical site, reducing effectiveness
- Pooled solution prevents proper adhesion of the dispersive electrode
Correct answer: Pooled flammable or caustic solution can ignite or cause chemical burns when exposed to ESU activation
Pooled prep solutions — especially alcohol-based ones — create a flammable reservoir that can ignite when the ESU is activated, and caustic solutions can cause chemical burns under the patient.
AORN Electrosurgical Safety 2
What distinguishes bipolar electrosurgery from monopolar electrosurgery?