These burns can lead to internal bleeding, lesions and infection.
Insulation breaks can be caused by mistreatment of instruments dur-
ing reprocessing or wear and tear from routine use.
Insulation failure is one of the top reasons for electrosurgery injuries
during laparoscopic procedures; research has found that 1 in 5 reusable
laparoscopic instruments have an insulation failure. The smaller the
break, the higher the amount of current that flows through it. While
breaks in the distal third of the laparoscopic instrument are the most
common cause of insulation failures, the most dangerous breaks occur
in the mid-shaft area, which surgeons can't see during procedures.
Because many insulation breaks aren't visible to the naked eye, ster-
ile processing techs should use porosity detectors to identify defects.
Surgeons, meanwhile, should take a moment before procedures begin
to run their hands down the laparoscopic instrument to make sure
they don't feel any apparent breaks. Surgeons can also reduce inci-
dents related to insulation failure by setting instruments to the safest
mode — the lowest power setting that's still effective and efficient —
and paying close attention during surgery to prevent the shaft from
touching adjacent tissue. Automated electrode monitoring (AEM) —
technology that automatically shuts down generator response systems
when stray current is detected — is another proven preventative tac-
tic.
2. Stray energy
Direct application failures occur when heat that's distributed during
the normal activation of an instrument injures adjacent structures like
non-targeted tissue. Surgeons must be careful to prevent burns
caused by the lateral spread of energy based on the device they're
using and the location of the instrument within the surgical field.
Luckily, a few simple, intuitive steps can prevent these types of
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