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    3 Equipment Safety Features Diathermy

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    izmcnorton
    This document summarizes key safety features and classifications of medical equipment. It discusses how equipment is classified based on factors like electrical class, intended use, leakage currents, and water resistance. Safety is ensured through features that minimize macro and micro shocks. Surgical diathermy is also described, including electrical hazards, settings, waveforms and precautions needed when using diathermy near pacemakers.

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    3 Equipment Safety Features Diathermy

    Uploaded by

    izmcnorton
    180 views64 pages
    This document summarizes key safety features and classifications of medical equipment. It discusses how equipment is classified based on factors like electrical class, intended use, leakage currents, and water resistance. Safety is ensured through features that minimize macro and micro shocks. Surgical diathermy is also described, including electrical hazards, settings, waveforms and precautions needed when using diathermy near pacemakers.

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    This document summarizes key safety features and classifications of medical equipment. It discusses how equipment is classified based on factors like electrical class, intended use, leakage currents, and water resistance. Safety is ensured through features that minimize macro and micro shocks. Surgical diathermy is also described, including electrical hazards, settings, waveforms and precautions needed when using diathermy near pacemakers.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    180 views64 pages

    3 Equipment Safety Features Diathermy

    Uploaded by

    izmcnorton
    This document summarizes key safety features and classifications of medical equipment. It discusses how equipment is classified based on factors like electrical class, intended use, leakage currents, and water resistance. Safety is ensured through features that minimize macro and micro shocks. Surgical diathermy is also described, including electrical hazards, settings, waveforms and precautions needed when using diathermy near pacemakers.

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    Equipment safety features

    Classification of devices
    ! ! ! Classification by class: Class I, II, III Classification by type: Type B,BF,CF Classification by suitability for use in flammable atmosphere: AP and APG Protection against ingress of water: IPX classification

    Class-I and III


    ! Class-I
    ! Basic insulation ! Earth

    ! Class II
    ! Double insulation

    ! Class III
    ! Safety Electrical Low Voltage (S.E.L.V) no > 25V for A.C and 60V for D.C

    Classification by type
    ! All diagnostic,therapeutic,life supporting or patient handling equipment must comply with type B, BF or CF specifications. ! Classified on the basis of permissible leakage currents.

    Leakage current
    L N E

    The current that does not return back via the neutral is the leakage current

    Type B

    Type BF

    Type CF

    AP

    AP G

    Class II

    Anaesthetic Proof

    Anaesthetic Proof G

    Type - B
    ! May have applied parts

    ! Maximum permissible leakage currents !below the thresholds for skin sensation (500A),! unlikely to cause any pain or injury ! e.g; thermometers, manometers, gas analysers and ventilator alarms

    Type - BF
    Type-F isolated circuits, suitable for applications where surface electrodes are used, diminishing the safety factor provided by normal skin resistance Maximum permissible leakage currents (500A), similar to those of type-B e.g Forced Air warmers, Blood warmers, Nerve stimulators etc

    Type - CF
    Most stringent protection against shock hazard Intended for applications where an intra-cardiac connections is likely Maximum permissible patient leakage current set at 1/10 (<50 A) of that for type B or BF devices e.g ECG, EMG, EEG , pacemakers and devices likely to be connected to cardiac catheters (such as syringe drivers and pressure transducers)

    Zones of Risk
    AP

    5-25 cms

    AP G

    0-5 cms

    Suitability for use in flammable atmosphere


    May be used in zone of risk 5-25 cm from an enclosed medical gas system Device must not be capable of igniting any mixture of explosive anaesthetic agent with air in normal use

    AP

    Standards met by prevention of static sparks, restriction of temperatures (<200oC) and energy levels, and by fireproof enclosures

    Suitability for use in flammable atmosphere


    May be used within the gas system itself or in the zone of maximum risk 0-5 cm from the gas system No device must be capable of igniting mixtures of explosive anaesthetic agents with oxygen or nitrous oxide, in both normal and first fault conditions Surface temp not > 900C

    AP G

    IPX Classification

    Drip Proof IPX - 1

    Splash Proof IPX 4

    Water tight IPX - 7

    Summary
    ! ! ! ! Macro and micro shock Safety features in prevention of shock How the equipment are made safe. Safety classification of equipment

    Electrical hazards can be minimised but not eliminated

    Surgical Diathermy
    Electrical Hazards

    Diathermy
    ! High frq current:
    ! 300KHz 3 MHz

    ! Current flow through patient :


    ! 200 400 mA ! Nearly 2 Amps (when used in Urology)

    Diathermy
    ! Cutting
    ! High Frq oscillation ! Sine wave pattern

    ! Coagulation
    ! Bursts of Lower Frq ! Damped , pulsed sine wave pattern

    Diathermy waveforms

    Time

    Cutting

    Time

    coagulation

    Time

    Blended

    Dessication and Coag


    ! Coag, when used on low power ! Dessication ! Relatively slow drying out of tissues by current that does not produce sparks

    Fulgration and Coag


    ! Coag with high power setting! Fulgration ! High power setting ! generates sparks ! intermittent heating of tissue ! cells to dry out quickly rather than explode into steam

    Power settings
    Power = Current 2 x Resistance ( R ) P= I2 X R

    Low Power < 30 watts


    ! ! ! ! ! ! Dermatology Laproscopy (Monopolar and Bipolar) Neurosurgery (Monopolar and Bipolar) Oral surgery Plastic surgery Vasectomies

    Medium Power
    Cutting 30 to 100 Watts Coagulation 30 to 70 Watts ! ! ! ! ! ! Gen Surgery Head and neck (ENT) Laparotomy Orthopaedics Surgery (Major) Thoracic Surgery Vascular surgery

    High Power
    Cutting > 100 Watts Coagulation > 70 Watts ! Ablative cancer surgery, mastectomies cut 180 300 watts, coag 70 120 ! Thoracotomy ( heavy fulguration 70 120 watts) ! Transurethral resections ( cut 100 170 watts, coag 70 120 watts)

    Active electrode

    Indifferent Electrode/ Plate

    Current density

    High Density

    Low Density

    Active Electrode

    Diathermy machine

    Bipolar

    Active Electrode

    Indifferent Electrode (Plate)

    Diathermy machine

    Monopolar

    Electrode
    ! ! Current flow: between Active electrode & indifferent electrode ( Plate ) Plate electrode connected in the machine in various ways.
    1.! Directly to the earth 2.! Isolation Capacitor 3.! Isolated Circuit

    Earthed Plate

    Active Electrode

    Indifferent Electrode (Plate)

    Diathermy machine

    Problems with earthed plate

    Diathermy machine

    120/80 mmHg

    Diathermy machine

    Isolating Capacitor
    0.01 F ! Reactance At diathermy frq!20! At 50 to 60 Hz !300,000!

    Isolation capacitor

    Diathermy machine

    Diathermy machine

    Diathermy machine

    Isolated Diathermy
    Floating Diathermy

    Active Electrode

    Indifferent Electrode (Plate)

    Isolated diathermy

    Active Electrode

    Indifferent Electrode (Plate)

    Isolated diathermy

    No contact ! No current flow ! No diathermy

    Active Electrode

    Indifferent Electrode (Plate)

    Isolated diathermy

    Plate Monitor

    Diathermy and pacemakers


    Dangers and precautions

    Pacemaker interference
    Depends on
    ! The type of pacing electrodes (i.e., unipolar or bipolar) in the patient ! How well the pacemaker circuitry is shielded and ! The strength and the proximity of the discharge from the electrosurgical unit.

    Diathermy and pacemakers


    PROBLEMS WITH USING DIATHERMY IN PATIENTS WITH PACEMAKERS

    DIRECT EFFECT OF THE DIATHERMY (MONOPOLAR)

    EFFECTS OF CAPACITANCE DUE TO HIGH FREQUENCY CURRENT ( DIATHERMY UNIT ITSELF, RF CURRENT GENERATOR)

    Direct effects

    PACEMAKER UNIT

    DIATHERMY UNIT

    Capacitive effects
    Diathermy noise ( RF )
    ! Inhibit or turn off any pacemaker " Complete Heart Block and no pacing ! Disrupt the pacing program in a programmable pacemaker " Severe tachycardia

    Diathermy and Pacemakers


    ! A preoperative consultation with a cardiologist. ! Be prepared to reset a pacemaker to the asynchronous mode (i.e., regular, uninhibited pacing).

    For complex pacemakers or patients


    ! Have a cardiologist and appropriate pacemaker programming equipment present or immediately available during surgery. ! External pacing equipment ( trans-cut or temp pacing) ! Isoprenaline (pharmacologic pacer, conc of 1 g/mL for small bolus injections t " : 7mins) Dose : 0.5 8.0 g/min

    Unipolar diathermy and Pacemakers


    ! Earth pads: As far away as possible from the pacemaker and its wires. ! The path from the earth pad to the diathermy tip should not traverse the pacemaker circuit.

    Conclusion: Diathermy and pacemakers


    ! Avoid as far as possible. ! Use bipolar ! If using monopolar
    ! Place the plate distant from the pacemaker. ! Do not apply the current across the chest ! Strength and duration of use should be minimal

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