CGRN Electrosurgery and Procedural Patient Safety — Questions and Answers
Question 1: Where should the return electrode (grounding pad) be placed for monopolar electrosurgery?
- Over a bony prominence near the procedure site
- On clean, dry skin over a well-vascularized muscle mass, away from metal implants (Correct answer)
- Over scar tissue to reduce sensation
- Directly over an implanted pacemaker
Correct answer: On clean, dry skin over a well-vascularized muscle mass, away from metal implants
Well-vascularized muscle spreads current safely and lowers the risk of burns at the pad site. Bony prominences, scar tissue, hairy or wet skin, and areas over metal implants or cardiac devices should be avoided.
Question 2: What is a key advantage of bipolar electrosurgery over monopolar electrosurgery?
- It needs a larger grounding pad
- Current flows only between two electrodes at the device tip, so no return pad is needed (Correct answer)
- It cuts tissue faster
- It is the only type allowed for polypectomy
Correct answer: Current flows only between two electrodes at the device tip, so no return pad is needed
In bipolar devices, current passes only between two electrodes at the tip. It does not travel through the patient's body to a dispersive pad. This lowers the risk of stray-current injury and of interference with implanted devices.
Question 3: Before polypectomy with electrocautery, a patient reports having an implantable cardioverter-defibrillator (ICD). What is the most appropriate nursing action?
- Proceed as usual; ICDs are not affected
- Tell the physician; arrange device management per cardiology/protocol and have a defibrillator available (Correct answer)
- Place the grounding pad over the ICD
- Cancel the procedure permanently
Correct answer: Tell the physician; arrange device management per cardiology/protocol and have a defibrillator available
Electrosurgical current can be sensed as a dangerous heart rhythm and trigger inappropriate shocks, or it can interfere with pacing. The ICD may need to be temporarily deactivated, for example with a magnet or reprogramming. The patient needs cardiac monitoring and an external defibrillator ready.
Question 4: What is the main reason CO2 insufflation is preferred over room air during colonoscopy?
- CO2 gives better image color
- CO2 is absorbed quickly, so there is less bloating and pain after the procedure (Correct answer)
- CO2 removes the need for sedation
- CO2 sterilizes the colon
Correct answer: CO2 is absorbed quickly, so there is less bloating and pain after the procedure
CO2 is absorbed through the bowel wall and breathed out about 150 times faster than air. This reduces bloating and pain after the procedure and lowers the risk of gas embolism.
Question 5: Why is a colon prepped with mannitol, or poorly prepped, dangerous when argon plasma coagulation (APC) or electrocautery is used?
- It increases sedation requirements
- Colonic gases such as hydrogen and methane can build up and ignite, causing a colonic explosion (Correct answer)
- It inactivates the argon gas
- It causes hypoglycemia
Correct answer: Colonic gases such as hydrogen and methane can build up and ignite, causing a colonic explosion
Bacteria ferment mannitol and residual stool, producing flammable hydrogen and methane. Electrosurgical energy can ignite these gases. Adequate non-fermentable bowel prep and gas exchange lower the risk.
Question 6: When should the universal protocol time-out be done for an endoscopic procedure?
- After the scope is inserted
- Right before the procedure begins, with the team confirming patient identity, procedure, consent and site (Correct answer)
- Only for procedures under general anesthesia
- At discharge
Correct answer: Right before the procedure begins, with the team confirming patient identity, procedure, consent and site
The Joint Commission's Universal Protocol requires a time-out right before starting. The whole team confirms the correct patient, the correct procedure, a signed consent and any relevant safety concerns, such as allergies, anticoagulants and implanted devices.
