高频电刀精编版课件.ppt

We call materials that are good carriers of electrosurgery Conductors - meaning they have a low level of resistance. Materials which have a high level of impedance are called Insulators. Blood is a good conductor of electrosurgery. Muscle, Skin and Fat are also conductors but have increasing levels of impedance. Bone has a high level of impedance, or resistance. Plastic is an insulator. That is why we wear latex gloves to insulate us from the electrosurgical instrument. 59 The sites represented here are all good sites, but not for any procedure. The most typical example is the calf. The calf is a good smooth and muscular site, but is not good for abdominal surgery because there is a poor structure between scalpel and plate. This poor structure is the knee, with almost no muscle but a lot of bone and ligaments. The only conductive structures here are skin and periostum. The chances of burns at the bone/tissue interface is very high. However, the calf is perfect for foot surgery. There are 2 articulations to avoid : the elbow and the knee. Shoulder and hip are OK because they are surrounded by good muscular masses . Basically, the choice of a good plate site is based on common sense. Try to visualize the current flow and the body structures between scalpel and plate. 60 For babies, it is often tricky to find good sites. For premature babies, it might be best to lie the baby down on top of the plate, the clamp pointing between the legs. Make sure all the edges are well applied around the baby抯 body. If the patient has an external or internal pacemaker, use electrosurgery with extreme caution. The electrosurgery generator can cause pacemakers “to enter an asynchronous mode or can block the pacemaker effect entirely.” Before using electrosurgery on a patient with a pacemaker, consult with the pacemaker manufacturer or facility cardiology department . Bipolar electrosurgery is the preferred modality for the patient with a pacemaker because of lower voltages needed