Association of periOperative Registered Nurses | AORN



Name: Date: Competency Statement: The perioperative RN has completed facility- or health care organization-required education and competency verification activities related to electrosurgery.1Guideline for safe use of energy-generating devices. Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016.Outcome Statement: The patient is free from signs and symptoms of electrical injury.2Petersen C, ed. Electrical injury. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:173-petency Statements/Performance CriteriaVerification Method[Select applicable code from legend at bottom of page]Not Met(Explain why)DEM/DO/DAKATS/SBT/CSVRWM/P&PO1.Explains the set-up of an electrosurgical unit (ESU) bya.describing the difference between monopolar and bipolar electrosurgery;b.describing foot pedal versus hand control;c.identifying connections for active and dispersive electrodes;d.describing how to use reusable, dispersive electrodes correctly; ande.describing correct use of the disposable, dispersive electrode.2.Uses only facility- or health care organization-approved ESU accessories.3.Identifies actions necessary to help ensure safety when using the ESU bya.verifying that the ESU is securely mounted to a tip-resistant surface, b.verifying that the ESU is not used as a shelf or table,c.verifying that liquids are not placed on the ESU,d.covering foot pedal accessories with fluid-resistant covers when there is a potential for fluid spills on the floor,e.verifying that safety and warning alarms are turned on to an audible level,f.turning the ESU settings to the lowest effective power setting to achieve the desired tissue effect,g.confirming power settings with the operating clinician before use,h.checking the entire ESU circuit (ie, ESU, hand piece and accessories, dispersive grounding pad, foot pedal) if the operating clinician repeatedly requires higher settings, i.handling all cords and plugs in a manner to prevent damage,j.checking the unit and cords/plugs for fraying and damage after use, k.placing the ESU in a manner to prevent tripping hazards from the power cord, and enabling the cord joining the active electrode to the generator to be placed as far as possible from or at 90 degrees to other cords (eg, cardiac and neuromuscular monitoring cords light cords, second electrosurgery cords).4.Identifies critical factors for correctly using the dispersive electrode (eg, placement over a well-perfused muscle mass, verifying uniform skin contact) bya.assessing and documenting the patient’s skin condition before placing the dispersive return electrode;b.choosing the proper size of dispersive return electrode for the patient (eg, does not cut the pad to fit the patient);c.verifying that there is adequate contact between the patient and the dispersive return electrode;d.using a separate, disposable dispersive pad for each ESU when using multiple ESUs;e.removing hair, if necessary, according to facility or health care organization policy and documenting the area clipped on the intraoperative record;f.removing or verifying removal of all jewelry that is in the current pathway between the active and dispersive electrode; verifying no metal is touching the patient (eg, metal bed components); andassessing and documenting the patient’s skin condition after removing the dispersive return electrode.5.Facilitates safe use of the active electrode bya.connecting the active electrode to the correct receptacle in the ESU;monitoring that the cord is attached to the drapes using a non-piercing, non-conductive device;c.monitoring that the active electrode is placed in the safety holster when it is not in use;d.monitoring that visible eschar is cleaned off the active electrode tip away from the incision;e.monitoring that the electrode cord is kept free of kinks and coils during use; andf.monitoring that the protective cap is replaced on the battery-powered, hand-held electrocautery device when the device is not in use.6.Follows fire safety precautions when using electrosurgery, includinga.verifying that nonflammable materials (eg, wet towel, sterile water or saline) are available on the field to extinguish a fire should one occur andb.monitoring that moistened sponges are used near the active electrode tip.7.Identifies considerations specific to using argon-enhanced coagulation technology.8.Describes the precautions necessary when using electrosurgery with a patient who has an implanted electronic device (IED) (eg, gastric or cardiac pacemaker; implantable cardioverter defibrillator; cochlear implant; deep brain, vagal nerve, sacral nerve, phrenic nerve, spinal cord, or bone stimulator).Consults with the team managing the IED before surgery or verifies the results of the pletes interventions recommended by the team managing the IED. pletes required documentation related to ESU use accurately, legibly, and completely according to the facility or health care organization policies and procedures.12.Verbalizes a review of facility or health care organization policies and procedures related to electrosurgery.13.Participates in assigned quality improvement activities related to electrosurgery.Concurrent competency verification of the following is recommended[Additional competencies related to electrosurgery as determined by the facility or health care organization] ................
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