Managing the risks associated with electrosurgical devices

What is it about?

Surgeons and interventional physicians routinely use the effects of electrosurgery for coagulation or tissue section. The most frequently used cutting and coagulation instrument in electrosurgery is the electrosurgical devices.

The use of this device can lead to care-related adverse events, generally related to dysfunction, inappropriate instrument use or misuse. Consequences are primarily skin or visceral burns and can have serious consequences for the patient if unrecognised or incorrectly managed.

This Patient Safety Solution proposes concrete actions (safety barriers) to prevent, recover or attenuate the risks associated with the use of electrosurgery. It recalls the importance of a good knowledge of the instrument and the enforcement of rules.

This Patient Safety Solution is intended for interventional teams (surgeons, practitioners, state-registered scrub nurses, state-registered anaesthesia nurses, circulating nurses and technicians, theatre manager and endoscopy nurses), for biomedical staff and for sterilisation staff.

Method

Two care-related adverse events declared by physician members of the FCVD (accreditation body for visceral and digestive surgery) in 2018 reported a fire in the operating theatre caused by the use of alcohol-based antiseptic and an electrosurgical device. The analysis of the FCVD feedback database allowed the identification of 876 declarations made between 2009 and 2016, corresponding to adverse events occurring when power sources were used in the operating theatre.

Moreover, a literature search has been conducted by the approved accreditation body.

Risk reduction tools

The adverse events in-depth analysis allowed identification of causes and circumstances of adverse events related to electrosurgical devices and propose a list of essential elements intended to question organisational and professional practices and to determine a number of actions for improving electrosurgical devices safety.

• Prevent: lists of safety prerequisites, of “what not to do” actions and of essential elements to prevent accidents are proposed.
• Recover: steps to take in the event of an accident when using the electrosurgical devices are proposed.
• Attenuate: steps to take in the event of a complication related to electrotome use are proposed.

Moreover, two factsheets (electrosurgical devices and fire in the operating theatre and electrosurgical devices and pacemakers) and five sheets specific to certain medical specialties are proposed.