Question

During an open colon resection, the surgeon encounters a bleeding vessel. A Crile hemostat is clamped onto the vessel to stop the bleeding. While the surgeon is holding the clamp, the CST applies the tip of the activated electrosurgical pencil to the hemostat to coagulate the vessel. Suddenly, the surgeon pulls her hand away, yelling aloud. Upon examination, she discovers a pinpoint third-degree burn on her right index finger.

1. Where should the tip of the electrosurgical pencil be placed in relation to the surgeon’s fingers to reduce the risk of injury?

2. Explain the principles behind the two possible causes for the burn.

3. What complications might result from the burn injury?

4. What is acting as the insulating material in this situation?

5. What three factors contributed to what occurred in this situation?

Answer 1

1.The tip of the Bovie or electrosurgical pencil should be placed below the fingers of the surgeon who is holding the forceps in order to reduce the risk of injury.

2.i) The first principle being the use of monopolar cautery instead of bi-polar cautery thus using more heat energy and causing a severe burn.

ii) The improper placement of the grounding electrode due to carelessness caused the conduction of heat to the fingers of the surgeon and caused the burn .

3. If the burn produced is severe burns it will result in white to brownish, dry, firm, third-degree burns which is surrounded by peripheral rings of second-degree burns. Severe skin damage may also result which may become malignant.

4. The clamp acts as the insulator in this case.

5.Burns from bovie pencil can be caused by:

(1) use of electrocautery instrument near inflammable and wet antiseptic cleansing agent

(2) contact of the skin with broken insulation of electric circuit of the instrument.

(3) accidental direct contact of skin with the active electrode, due to a puncture in the surgical gloves.