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Challenges in Preventing Electrical, Thermal, and Radiation Injuries

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Surgical Patient Care

Abstract

Energy—its use in various forms during surgery has tremendously advanced our practice of surgery since the 1920s with the introduction of the first electrosurgical units by William Bovie, MD. Each type of energy—electricity, heat, and radiation (including intense MRI magnetic fields)—presents variable risks of injury to patients if the risks are not recognized and care not taken to prevent harm. Intraoperative injuries that are suspected of being caused by a medical device/implement and its related energy may not be related to a technology. In many cases, the injury may be an abnormal or idiosyncratic physiologic response to otherwise normal conditions of device use and performance. Alternatively, the injury may be due to pressure necrosis, tissue chemical sensitivity, an adverse drug reaction, or a disease process that happens to develop in the area where a device was applied. Such alternative etiologies, beyond those from energy emitting technologies, are briefly discussed. This chapter addresses the etiology of intraoperative skin and tissue injuries from medical technologies that are the source of electrical, thermal, and radiation energy. A format for investigating such injuries is presented along with guidance on their prevention. The hazards of surgical fire on the patient are also addressed.

“When you have eliminated all which is impossible, then whatever remains, however improbable, must be the truth.”

—Arthur Conan Doyle

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Author information

Authors and Affiliations

  1. ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA, 19462, USA

    Mark E. Bruley CCE, BSc

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  1. Mark E. Bruley CCE, BSc
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Correspondence to Mark E. Bruley CCE, BSc .

Editor information

Editors and Affiliations

  1. Department of Surgery Ascension Saint Agnes Hospital Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Juan A. Sanchez

  2. Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA

    Paul Barach

  3. Department of Surgery Center for Healthcare Studies Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Julie K. Johnson

  4. Division of Cardiovascular Surgery Johns Hopkins All Children’s Heart Institute Johns Hopkins All Children’s Hospital, Johns Hopkins University, Saint Petersburg, FL, USA

    Jeffrey P. Jacobs

Appendices

Appendix 1: Questionnaire for Investigating Accidental Perioperative Skin or Tissue Injury [51]

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Reprinted with permission. Copyright 2005 ECRI Institute. www.ecri.org. 5200 Butler Pike, Plymouth Meeting, PA 19462. 610-825-6000.

Note: For a detailed discussion of how to use this questionnaire, refer to the text in Chap. 19 above.

Do not file the completed questionnaires with the patient’s medical records.

When beginning the investigation of a perioperative skin or tissue injury, record the baseline patient and equipment information first. Then, copy the partially completed questionnaire, and record answers to the remaining questions during each interview. Complete one questionnaire for each person interviewed. If needed, attach additional sheets to answer questions. Be sure to record the interviewee’s name and your name on all attached sheets.

To ensure objectivity, no one who had primary responsibility for the patient before or after the injury should be included on the team investigating the incident, but they may well contribute to the investigation during the interview process. Similarly, engineering or other staff who had responsibility for the most recent performance inspection, repair, or calibration of the medical devices suspected of having been involved in the cause of the injury should not be included on the team.

Appendix 2: Posters—Preventing Surgical Fires and Extinguishing Fires Burning On or In a Patient [41, 42]

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Reprinted with permission. Copyright 2009 ECRI Institute. www.ecri.org. 5200 Butler Pike, Plymouth Meeting, PA 19462. 610-825-6000.

Downloadable copies of these posters on prevention and extinguishment of surgical fires are available online at www.ecri.org/surgical_fires.

For all fires, save involved materials and devices for later investigation.

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Bruley, M.E. (2017). Challenges in Preventing Electrical, Thermal, and Radiation Injuries. In: Sanchez, J., Barach, P., Johnson, J., Jacobs, J. (eds) Surgical Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-44010-1_31

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