State of Shock – Part 2

Last week we explored the differences between Monopolar and Bipolar electrosurgery and highlighted common instruments used in these procedures. Now, let’s examine the risks associated with damaged Monopolar instruments and the steps needed to prevent potentially catastrophic outcomes.
The Risks of Damaged Insulation

In Monopolar electrosurgery, the instrument’s insulation ensures the electrical current flows safely through the forceps or scissors. The coating, often applied using a nylon powder, must be thick and flawless to prevent electricity from escaping.
If the insulation is compromised—through pinprick holes, cracks, or wear—electricity can escape, potentially causing burns or shocks to the surgeon, operating staff, or patient. This risk is particularly acute in laparoscopic procedures, where most of the instrument operates within the patient’s body. Any unseen damage could lead to fatal complications.

Ensuring Safety Through Testing
All electrosurgical equipment must be inspected and tested regularly to detect flaws in the insulation. Devices like the Diateg tester are specifically designed for this purpose, applying enough power to reveal even the smallest imperfections in a forcep’s coating. These testers can also evaluate leads, provided the correct settings are used.

Preventing Damage
To minimise the risk of insulation damage:
• Avoid using heavy-duty brushes to clean instruments, particularly on laparoscopic tools like J-hooks. Opt for coated hard tips to prevent damage.
• Be vigilant about the effects of repeated sterilisation, which can make coatings brittle over time.
• Monitor instruments used at high power, as extreme heat can weaken or break insulation.
• Always inspect instruments before and after use, flagging any visible damage to ensure they are not returned to surgical trays.

Repair or Replace?
If damage is discovered, the instrument should be clearly marked and set aside. In many cases, damaged coatings can be repaired, restoring the instrument to a safe and functional condition. If repair isn’t feasible, the instrument must be replaced to ensure patient and operator safety.
By maintaining rigorous inspection and care standards, surgical teams can mitigate the risks associated with damaged electrosurgical instruments, protecting both their patients and themselves.