It is important, however, to pay attention to any cables connecting accessories or the foot pedal to the generator, as leakage currents are greater along these. Never bundle cords or lay them directly in contact with a patient’s skin—whether that patient is wearing jewelry or not. Similarly, don’t bundle or entwine active cords or grounding pad cables with cords leading from monitoring electrodes.
3. Fact: Metal objects, including jewelry, in the direct path of current flow CAN concentrate electrosurgical energy. This is one reason (presence of scar tissue is another) that staff should not place return electrodes (grounding pads) over metal implants. Never place the grounding pad directly over any piece of metal (i.e. have jewelry or a gown snap stuck to the pad gel between the patient and the pad).
In monopolar electrosurgery, the current flows from the active site (i.e. snare) following a path of least resistance to the grounding pad to be collected and returned to the generator to complete the circuit.
In the case of a colon polyp with a grounding pad placed on the thigh, ear or finger rings, or a tongue stud, would not be in the current path and would be of no concern. A genital piercing however, may have at least a theoretical risk of being in the current path and therefore, at risk of some heating, although no burns are known to have been reported from this cause.
If it is not possible to remove such a genital item, staff may use careful watching and reporting by a conscious patient to help mitigate the minor risk. Choose the lowest power setting possible to successfully complete the procedure. It may be of benefit to interrupt the application of power periodically to allow for tissue cooling if the procedure is lengthy.
GI has an excellent record for electrosurgical safety. GI procedures tend to occur at lower voltages and power settings and for shorter activation times than general surgical applications.
This helps naturally to minimize safety risks, but does not eliminate the pressing need for user education. Give yourself confidence, and your patients the best care by learning the fundamentals of the technology of electrosurgery and the facts about its risks.
Marcia L. Morris has been involved with electrosurgery in GI since 1987. She has worked with multiple manufacturers helping to design, develop and market electrosurgical generators and accessories, and is currently the CEO of Genii, Inc. She is a peer-reviewed author on the technology, a frequent lecturer at physician and nursing conferences, and has developed educational materials used by gastroenterology residents and fellows.
