RSVP Ebd Fy23 Ft10 Series Juli 2023

EVIDENCE
RECOMMENDED SAFETY PRACTICE

BASED:
FOR ELECTROSURGERY
Presented
Muhammad Hidayat Faisal
Product specialist and
National Service
Coordinator
Elec t r i cal
Basic Theory
• Selalu mencari hambatan yang paling

kecil
• Dan selalu mencari “grounding”

Komponen
Kelistrikan
Sumber
Tegangan
Sirkuit
Impedansi /
Hambatan
Arus
listrik
BASIC PRINCIPLES OF ELECTRICITY IN
SURGERY
PRO PERTIES O F ELECTRICITY
Properties1
Current
Flow of electrons during a period of
time, measured in amperes
Circuit
Pathway for the uninterrupted flow of
electrons (must be complete/closed to flow)
Impedance
Resistance to the flow of current
measured in ohms
Voltage
Force pushing current through the Electricity
resistance, measured in volts seeks the path
of
least resistance
4 © 2019 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. ™* Third party brands
are trademarks of their respective owners. All other brands are trademarks of a Medtronic company. 8/2019-US181098-[WF2441443]
Elec t rosur ger y
Basic Theory
Arus
listrik
Sumber Sirkuit
Tegangan
Impedansi /
Hambatan
Konsentrasi
Arus istrik
Pri nsi p Elec t rosur ger y
Monopolar
Bipolar
FREQUENCY
SPECTRUM
NO SHO CK
TO PATIENT
Panjang Gelombang
Elec t rosur ger y
Perkembangan Electrosurgery
2015
1926 RF 1968 – 1999 Tissue 2006 Tissue
1981 – REM 1995 IRT TISSUEFEC
ESU Solid state fusion Sensing
T
MONOPOLAR ELECTROSURGERY BASICS
VARIABLES THAT IMPACT
ELECTRO SURGERY
ELECTRODE WAVEFORMS GENERATOR POWER TIM THE

TYPE CAPABILITY SETTING E PATIEN
S T
MONOPOLAR ELECTROSURGERY
BASICS
ELECTRODE IMPACT O F CURRENT CO NCENTRATIO N
TYPE
BASICS
WAVEFORMS WAVEFORMS
Lower Higher
Voltage Voltage
BASICS
WAVEFORMS THERMAL SPREAD
RW
1
PURE CUT BLEND COAG
LOW HIGH
Thermal
Spread/Charring
Voltage
are trademarks of their respective owners. All other brands are trademarks of a Medtronic company. 8/2019 US181098-[WF2441443]
Slide 17
RW1 Todd asked about the citation. These animations were created for us and come directly from approved document
MTS10309. These are straightforward concepts so it's my belief that no citation is necessary here Riseley, Will, 4/10/2019
ACTIVATIO N O N/O FF TIMES 3
TIME
 Extended activations of the active

electrode should be avoided
 Per Valleylab™ patient return electrode
IFUs, a 25% duty cycle should be adhered
to (30 seconds off for every 10 seconds on)
BASICS
GENERATOR
ADDITIO NAL MO DALITIES
CAPABILITY
Cut Electrosurgical
Modalities Technique
Coag
Modalities
GENERATO R CAPABILITY – TISSUEFECT ™
GENERATOR
TECHNO LO GY
CAPABILITY
Monitors changes in tissue

impedance 434,000
times/sec 4
Adjusts energy output to deliver

appropriate amount of energy for desired
tissue effect 4
Results in enhanced (greater consistency and

efficiency) performance of monopolar
† As compared with ForceTriad™ Energy
devices4,5†
Platform
BASICS
INFLUENCE O F THE
THE
PATIENT PATIENT
Each patient on the OR table is unique. It is important to be aware of how different body types may
impact the output and efficiency of surgical energy
§
INJURY
PREVENTION
40,000 burns per year
caused by Electrosurgery
7,†
$600MM/YR
22
LIABILITY 7,† .
© 2019 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. ™* Third party brands
† In the United States, data from 1999 study

Electrosurgery
Sistem Grounding
“Menjawab semua kebutuhan di masa

depan. . .”
Cushing, 1927
Namun ...
Generator sistem grounding selalu mencari grounding

terdekat
Electrosurgery
Sistem Grounding
Generator sistem grounding tidak direkomendasikan untuk

digunakan
ECRI, 1995
Hindari
Cidera yang bisa terjadi dengan sistem grounding
Penggunaan generator dengan

sistem tersiolasi bisa
menghilangkan resiko cidera
AORN Recommended Practices 2008
Electrosurgery
Sistem Terisolasi
Power
Outlet
Hindari
Cidera yang bisa terjadi dengan sistem grounding
Sejarah mencatat, cedera yang

sering terjadi akibat pemakaian
ESU ada pada lokasi penempatan
“patient pad”
Penggunaan patient pad yang

memiliki teknologi return
electrode Contact Quality
Monitoring, dapat
meminimalisasi resiko cidera
pada pasien

Contact Quality Monitoring
Therapeutic
current
Interrogation
current
Ikuti Petunjuk Pemakaian dari Pabrik
SOP
• Generator dan
accessories harus
digunakan sesuai
petunjuk pemakaian.
• Setiap tipe generator
mempunyai petunjuk
pemakaian yang
berbeda
• Accessories harus
digunakan sesuai petunjuk
pemakaian
Elec t rosur ger y
Petunjuk Keselamatan
Bipolar Monopolla
r
Memilih Patient Pad
• Patien plate harus kompatibel dengan
generatornya.
– Jangan menggunakan patient plate yang
mematikan/melumpuhkan sistem contact
quality monitoring
(Generator valleylab mempunyai sistem
pengamanan, yang hanya berfungsi bila
menggunakan patient plate merk valeylab)
• Periksa Apakah:
– Patient plate masih utuh
– Conductive gel masih ada dan lembab
– Expire date masih jauh
• Patient Plate tidak boleh di reuse (1 kali pakai)
INJURY PREVENTION
SELECTING THE RIGHT
PRE Adult
Select patient electrode
according to patient
>30
weight
lbs
Infant
6– 30
lbs
Neonatal
1– 6 lbs
Elec t rosur ger y
REM Polyhesive ™II
Single Use Patient Return Electrodes
Technical Specs
NEONATAL INFANT ADULT ADULT
REM Polyhesive ™ REM Polyhesive ™ REM Polyhesive ™ NON-REM
Polyhesive ™
E7512 E7510-25 / E7510- E7507 / E7508 / E7506

Product Code 25DB E7509
Overall Dimensions 5,3 x 9,8 cm 9,5 x 12,1 cm 18,3 x 11,4 cm 18,3 x 11,4 cm
Conductive Surface Area 33 cm2 75 cm2 137 cm2 137 cm2
1~6lbs 6~30lbs
Weight Limits (0.45~2.7kg) (2.7~13.5kg)
0,71cm Including 2nd 0,95cm Including 2nd
liner over border when liner over border when
fluid seal is not fluid seal is not 1,11 cm 1,11cm
Border Adhesive required required
Backing Material Polyethylene foam

Cord Withstands 4000v (RMS) at 60Hz
35 |
Memilih Area Pemasangan Patient Pad
• Ikuti Petunjuk pemakaian dari Pabrik

• Sebaiknya penempatan patien plate:
– Kulit yang Bersih & kering ( non
Steril )
– Daerah yang luas, masa otot yang
bagus
– Dekat dengan area operasi
– Daerah yang Cembung
INJURY PREVENTION
PREVENTING PAD SITE
BURNS
Patient Return
Placement
Electrode
The PRE should be placed as close

to
the surgical site as possible while
adhering to other placement
guidelines found in product IFUs
and per accepted hospital
protocols3
INJURY PREVENTION
PREVENTING PAD SITE
BURNS
CAUTION: DO NOT 3
 Warm
 Cut or modify
 Overlap edges
 Apply after positioning
 Put sustained pressure
on pad site
 Prep site with
flammable
solutions
 Allow liquid to get
between pad and patient
*Where necessary, please remove hair per hospital guidelines. Razor in animation is for demonstration/representation purposes
only
© 2019 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. ™* Third party brands
INJURY PREVENTION
PREVENTING PAD SITE
BURNS
CAUTION:
AVOID 10
Hindari Pemasangan Patient Pad Pada
Daerah yang ada protesa /

Daerah
Impal bertulang
Daerah Bekas Daerah Berambut

Luka
Ball,
2004
Persiapan Pemasangan Patient Pad
Ikuti Petunjuk Pemakaian Lindungi Patient Jangan gunakan cairan yang

untuk memotong, plate dari mudah terbakar
membersihkan dan masukanya cairan
mengeringkan area
AORN Recommended Practices

2008
Petunjuk Pemasangan Patient Pad
Jangan Jangan di potong atau di

Overlap modifikasi

2008
• Pilih patient plate sesuai dengan berat pasien

• Infant patient plate
– Power jangan melebihi 120 watts
– Gunakan aktivasi yang pendek-pendek
• Neonatal patient plate

– Hindari Aktivasi lebih dari 30 detik
– Untuk neonates < 0.45 kg,
gunakan bipolar

2008
• Patient plate jangan dihangatkan

• Pasang Patient plate setelah pasien diposisikan
• Letakan Patient plate dekat ke
tourniquet, Sebaiknya pada sisi tempat
operasi

2008 Hotline News, 2003
Petunjuk Pemasangan 2 buah Patient Pad
• Pasien obesitas
• Pasien yang terlalu kurus
• Dan Prosedur yang
membutuhkan waktu lama

2008
Petunjuk Penyimpanan Elektroda Aktif
Elektroda aktif harus dimasukkan

ke dalam sarung non-konduktif
(holster) pada saat tidak digunakan

2008
Elektroda Aktif
Jangan gunakan karet merah atau material

lainnya sebagai pelindung elektroda aktif
– Karet atau plastik mudah terbakar
– Selalu gunakan tip terinsulasi yang
direkomendasikan pabrik
Kebocoran Arus
• Kabel kabel jangan di lilitkan ke

instrument
• Kabel pencil ,kabel patient pad dan
kabel dari alat alat lain jangan di
satukan(bundel) bersama sama.
Petunjuk Pembakaran Hemostat
– Jangan hemostat” dengan elctrode

bentuk jarum
– Jangan bersandar pada pasien, meja,
atau retraktor saat aktivasi
– Lebih baik pakai cut dari pada coag
– Pegang dengan benar sebelum aktifasi
– Pencil dibawah tangan jangan diatas
tangan
– Tempelkan pencil dulu baru aktivasi
Perhatian :
Sarung tangan tidak dapat menginsulasi arus
RF
Pasien dengan alat pacu jantung
• Konsultasikan dengan pabrikan alat

pacu jantung
• Gunakan bipolar
• Gunakan seting energi yang rendah
• Hindari arus melalui jantung dan
alat pacu jantung
• Jauhkan kabel dari alat pacu
jantung

2008
Pasien Dengan Perhiasan
• Pastikan pasien sudah tidak

mengenakan perhiasan/logam pada
tubuhnya
2008
Pasien dengan tubuh penuh tato
• Hidari penempatan patient plate pada tatto

• Tinta warna merah mengandung besi
bisa menimbulkan panas atau
konduktor listrik
Valleylab Clinical
Hotline
SOP Penggunanaan ESU
1. Nyalakan generator Pastikan alat bekerja dengan baik (Sebelum Patien masuk OK)
2. Posisikan pasien sesuai tindakan yg akan dilakukan
3. Pasang Patien pad, ke patien dan sambungkan ke alat
4. Pasang pincils ke alat dan tempatkan di tempat yg aman.
5. Setelah user siap untuk insisi setting power sesuai kebutuhan atau sesuai
yang di recomendasikan.
6. Jika di perlukan tambah atau kurangi powe sesuai permintaan user
7. Setelah oprasi selesai matikan generator terlebih dahulu dan cabut pincils dan patien
pad pada alat
Valleylab Clinical
Hotline
Surgical Smoke
Gas yang diproduksi dari hasil vaporisasi jaringan protein dan

lemak
Surgical Smoke
xylen
benzen
e e
cyanid
e
Surgical Smoke
Chemical Health Effects
Acetaldehyde Eye, skin, respiratory irritant; causes

erythema, coughing, pulmonary edema; may
be teratogenic
Acrolein Eye, skin, respiratory irritant; liver kidney

damage; increased clotting time
Acetonitrile Nose irritant, throat asphyxiant; liver and

kidney damage in animal models
Benzene Headache, fatigue, weakness; bone marrow

damage; trigger for leukemia
Styrene Respiratory irritant; vapors cause nose lining

damage in animal models
Toluene Eye, respiratory irritant; CNS function;

teratogenesis with high inhalation levels
Xylene Respiratory irritant; chronic exposure

associated with changes in blood cells
Surgical Smoke
• “The mutagenic effect created by thermal destruction of 1 g of tissue

is equivalent to that of three or six cigarettes for laser and
electrocautery smoke, respectively.” (W.L. Barrett, Surgical smoke: a
review of the literature, Surgical Endoscopy 17 (2003), pp. 979–
987).
• “The components of surgical smoke have been described as being, at the

very least, a nuisance and, at worst, carcinogenic.” (
http://findarticles.com/p/articles/mi_m0FSL/is_4_87/ai_n25374211/)
Valleylab E2100 Series Reusable
Pencil
With electrode
All Disposable Pencils
Rocker switch with arthroscopic

electrode
Suction Coagulator
Footor button activated
Push button
Rocker switch
All Pencils (Exc Foot activated) packed with blade & quiver
Disposable Active Electrodes – Stainless
steel
E1551-6 Extended blade electrode
E1552-6 Extended needle electrode
E1511 Arthroscopy electrode (Also: E1510, E1512, & E1513)
E1551G Blade (E1551X with Hex lock)
E1552 Needle electrode E1550 Ball electrode

ALSO:
E1504 / E1502 Electrode extensions – (Re-Usable)
Disposable Loop Electrodes – Stainless Steel
(LLETZ)
E1559
E1560
E1561
E1562
Standard EDGE™
Electrodes
E1450-6 & 4 Extended blade electrode
E1452-6 Extended needle electrode

E1452 Needle electrode
E1450G & X + E1475X Blade ( Use with

Accuvac)
Insulated EDGE™
E1455 Electrodes E1455-4
E1455B-4
E1455B
E1455-6
E1465 E1465-4
E1465B E1465B-4
E1465-6
ANATOMY OF
SUCTION
COAGULATORS
Shock Guard/ Bendable, Insulated
Suction Hole Shaft
Coag
Suction
Connection
Cable to Coagulating Tip

Generator
Re-Usable
Electrodes
E1000 Small ball
E1502 Electrode extension
E1001 Blade
E1020 Blade
E1002 Large ball
E1003 Needle
E1004 angled ball
E1005 Loop
Adaptors &
Cables
E0017
E0507-B
E0560 Re-Usable plate cable for E7509 plates

E0560E Plate cable (Erbe ESU’s)
OPTI 2 Solid Laparoscopic
Electrodes
E2770-28 Str Spat
E2771-28 Curved Spat
E2772-28 Wire J Hook
E2773-28 Wire L
Hook
E2774-28 Flat L Hook

OPTI 4 Hollow Laparoscopic
Electrodes
E2780-28 Str Spat E2781R-28ASP (Retractable electrode)
All OPTI 4 Electrodes are also available as

E2781-28 Curved Spat Retractable electrodes
E2782-28 Wire J Hook Electrode Fit
Connection to ESU E2750

Irrigation button
E2783-28 Wire L Hook
E2784-28 Flat L Hook

Irrigation
Aspiration Aspiration button ES Activation
E2786-28 Cylindrical tip
Bipolar
Forceps
E4058CT
E4062CT
E4060CT
FOOTSWITCH
Bi-Polar
E6009
Mono-Polar
E6008B
Surgical Smoke
REFERENCES
1. Ulmer, B. Electrosurgery Self-Study Guide. Boulder, CO: Covidien Energy-Based Devices, 2010, p. 5
2. Based on Covidien product verification report: "Ex vivo Monopolar Thermal Effect Evaluation on the Valleylab™ FT10 " January - February,
2015; RE0064439 Rev A Based on Covidien In-vivo GLP Acute report: "Verification – Report – GLP Acute Animal Lab – LigaSureTM Preclinical
Evaluation of Valleylab™ FT10." May 19, 2015: RE00005503. FT10 CM3 Document
3. Product E7507/E7507DB Product Instructions for Use. “Intended Use” Section, Page 2
4. McHenry J, Dunning J, Wagle K. Valleylab™ FT10 Energy Platform Tissuefect™ Technology. October 2015. Boulder, CO. Medtronic White
Paper, part number: US150755
5. Based on Covidien ex-vivo monopolar report: "Verification - report - Ex-vivo Monopolar Procedural Flow Evaluation on the Valleylab™ FT10
Orion." November, 2014; R0064443 Rev A. FT10 CM3 Document
6. Based on Covidien In-vivo GLP Acute report: "Verification – Report – GLP Acute Animal Lab – LigaSureTM Preclinical Evaluation of Valleylab™
FT10." May 19, 2015: RE00005503. FT10 CM3 Document
7. Jones, et al. Safe Energy Use in the Operating Room. 2012;52:447-468
8. Overbey D, Townsend N, Chapman B, et al. Surgical energy-based device injuries and fatalities reported to the Food and Drug
Administration. J Am Coll Surg. 2015;221(1):197-205
9. Bisinotto, FMB et al. Burns Related to Electrosurgery-Report of Two Cases. Sociedade Brasileira de Anestesiollogia. 2015:3
10. CSA Group: Standards Update Service Z387-13. “Safe Use of Electrosurgical Medical Devices and Systems in Healthcare” January 2013.
11. Alkatout et al. Principles and Safety Measures of Electrosurgery in Laparoscopy. JSLS (2012) 16: 130-139

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EVIDENCE

RECOMMENDED SAFETY PRACTICE

• Selalu mencari hambatan yang paling

• Dan selalu mencari “grounding”

ELECTRODE WAVEFORMS GENERATOR POWER TIM THE

PURE CUT BLEND COAG

 Extended activations of the active

Monitors changes in tissue

Adjusts energy output to deliver

Results in enhanced (greater consistency and

† In the United States, data from 1999 study

“Menjawab semua kebutuhan di masa

Generator sistem grounding selalu mencari grounding

Generator sistem grounding tidak direkomendasikan untuk

Penggunaan generator dengan

Sejarah mencatat, cedera yang

Penggunaan patient pad yang

AORN Recommended Practices 2008

E7512 E7510-25 / E7510- E7507 / E7508 / E7506

Backing Material Polyethylene foam

• Ikuti Petunjuk pemakaian dari Pabrik

The PRE should be placed as close

Daerah yang ada protesa /

Daerah Bekas Daerah Berambut

Ikuti Petunjuk Pemakaian Lindungi Patient Jangan gunakan cairan yang

AORN Recommended Practices

Jangan Jangan di potong atau di

AORN Recommended Practices

• Pilih patient plate sesuai dengan berat pasien

• Neonatal patient plate

AORN Recommended Practices

• Patient plate jangan dihangatkan

AORN Recommended Practices

AORN Recommended Practices

Elektroda aktif harus dimasukkan

AORN Recommended Practices

Jangan gunakan karet merah atau material

• Kabel kabel jangan di lilitkan ke

– Jangan hemostat” dengan elctrode

• Konsultasikan dengan pabrikan alat

AORN Recommended Practices

• Pastikan pasien sudah tidak

• Hidari penempatan patient plate pada tatto

Gas yang diproduksi dari hasil vaporisasi jaringan protein dan

Acetaldehyde Eye, skin, respiratory irritant; causes

Acrolein Eye, skin, respiratory irritant; liver kidney

Acetonitrile Nose irritant, throat asphyxiant; liver and

Benzene Headache, fatigue, weakness; bone marrow

Styrene Respiratory irritant; vapors cause nose lining

Toluene Eye, respiratory irritant; CNS function;

Xylene Respiratory irritant; chronic exposure

• “The mutagenic effect created by thermal destruction of 1 g of tissue

• “The components of surgical smoke have been described as being, at the

Rocker switch with arthroscopic

E1552-6 Extended needle electrode

E1511 Arthroscopy electrode (Also: E1510, E1512, & E1513)

E1551G Blade (E1551X with Hex lock)

E1552 Needle electrode E1550 Ball electrode