Electrosurgery is simply defined as a surgical procedure that uses a high frequency electric current to heat biological tissue in order to cut, coagulate or fulgurate the tissue. Electrosurgery has been successfully used in dermatology, gynecology, plastic surgery, urology, and in some veterinary applications.
The science of electrosurgery demands a specific configuration to ensure success and safety. In a monopolar configuration, the closing of the electric current circuit requires a return electrode at the end of the loop, so the current passes from the primary electrode, through the tissue and back to the return electrode, which is attached to the patient as a large metallic plate that returns the current back to the AC source or generator.
The return electrode that attaches to the patient is called the grounding pad, and modern systems can use disposable or reusable grounding pads.
Disposable grounding pads
Disposable grounding pads are made of a plastic base material that is covered with a metal film that serves as the actual electrode surface. Covering the metal surface is an adhesive gel layer that can be easily attached to the patient’s skin. Also referred to as single use pads or sticky pads, the disposable grounding pad must be large enough to keep the current density low to prevent heat build up that might result in a burn under the pad.
One of the biggest benefits of disposable grounding pads is that they come in various sizes which can help ensure they fit the patient properly and are more cost effective than reusable pads. Single use also facilitates sterility during the procedure and a quick and efficient cleanup afterwards. Disposables contain high quality adhesives that help conform the fit to the patient and enables consistent heat distribution.
Reusable grounding pads
Although cost effective and versatile, disposable grounding pads can cause patient skin problems such as hypersensitivities, allergies, and even removal of layers of skin when the pad is removed. Additionally, many practitioners are concerned with the wastefulness of disposable pads. Advanced technology has introduced the reusable pad that reduces and in most cases eliminates the negative results of using disposables.
The primary function of these reusable pads is to disperse electrosurgical energy over a large surface area but additional advantages exist. A reusable grounding pad will limit current flow as necessary – by limiting the current flow, the current density is kept sufficiently low enough to prevent heat build up, and so reduce burns at the pad site. The reusable pad also eliminates the disposable grounding pad issues with being placed over tissues that are unable to sufficiently conduct electricity. These include excess hair, fat in obese patients, and scar tissue.
When conducting a patient assessment before the procedure, know the type of patient pad that will be used and ensure that if using a disposable pad, the possible concerns are evaluated. Select the right pad for the equipment, and for the patient