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PLACING AN ELECTROSURGICAL UNIT DISPERSIVE ELECTRODE OVER A TATTOO

AORN journal, 2024-02, Vol.119 (2), p.171-173 [Peer Reviewed Journal]

Copyright John Wiley & Sons, Inc. Feb 2024 ;ISSN: 0001-2092 ;EISSN: 1878-0369

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  • Title:
    PLACING AN ELECTROSURGICAL UNIT DISPERSIVE ELECTRODE OVER A TATTOO
  • Subjects: Body piercing ; Burns ; Electric currents ; Electrodes ; Emergency medical care ; Jewelry ; Magnetic resonance imaging ; Ratings & rankings ; Skin ; Tattoos ; Transplants & implants
  • Is Part Of: AORN journal, 2024-02, Vol.119 (2), p.171-173
  • Description: Answer: The single-use electrosurgical unit (ESU) dispersive electrode should be placed in an area with adequate skin surface to disperse the current and reduce the risk of localized heating of tissue.1 Perioperative personnel placing the dispersive electrode should follow the manufacturer's instructions for use2 and report any incidences of adverse reactions related to ESU use among patients to MedWatch, the US Food and Drug Administration's adverse event-reporting program.3 More detailed guidance on the placement of single-use ESU dispersive electrodes, commonly referred to as "Bovie pads," is available in Table 1. An ESU dispersive electrode can be placed over a tattoo if the area meets other recommendations for dispersive electrode placement and it is the best choice for pad placement.1 However, it should not be the preferred location for the dispersive electrode placement because ESU dispersive electrode burns may still occur for other unspecified reasons and the tattoo could become damaged.4 According to ECRİ (formerly the Emergency Care Research Institute), placing an ESU dispersive electrode over a tattoo will not increase the risk of burns because the mass of the skin is considerably greater than the mass of the tattoo pigment in the skin.4 Concerns about placing an ESU dispersive electrode over a tattoo are based on the premise that metallic pigment in the tattoo may increase the risk of a burn in the location where the dispersive electrode is placed.4 According to ECRİ, these concerns are no longer applicable because "modern ESUs have an 'isolated' design, meaning that they greatly reduce the risk of unintended patient burns via ground-seeking current,"4 unlike older types of ESUs that "involved a patient-generator circuit that was electrically referenced to ground"4 where the electrical current could be conducted or grounded through conductive objects such as body piercings or jewelry in contact with the patient.4 The eighth item on ECRI's top 10 list of health technology hazards in 2023 was "Common Misconceptions About Electrosurgery Can Lead to Serious Burns. "5 According to ECRİ, assumptions that an ESU dispersive electrode "can never be safely applied over an orthopedic metal implant, tattoo, or piercing"1 may lead personnel to place the electrode in a less desirable location (eg, over a bony prominence), thereby potentially increasing the patient's risk of a burn.1 Because bone prevents uniform dispersion of electrical current, placing the dispersive electrode over a bony prominence can concentrate the electrical current to a small area and contribute to excessive heating at the site of electrode placement.1 In general, dispersive electrodes also should not be placed over pacemakers or other electronically active implants.1 From 2004 to 2016, AORN recommended against placing dispersive electrodes over tattoos based on theoretical concerns that the metal in tattoo ink could be heated and increase the patient's risk for tissue injury or burns.6 8 These retired AORN recommendations were based on case reports of tattoos heating during magnetic resonance imaging and resulting in a spectrum of reactions, including burning sensations, inflammation,910 and second-degree burns.1112 Since 2016, the AORN guidelines no longer contain recommendations regarding placement of a dispersive electrode over a tattoo.13 This decision to remove the recommendation on placement of dispersive electrodes over a tattoo was made because the evidence supporting the recommendation was not specific to use of energy devices in surgery.
  • Publisher: Denver: John Wiley & Sons, Inc
  • Language: English
  • Identifier: ISSN: 0001-2092
    EISSN: 1878-0369
  • Source: ProQuest Central
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