Report on Diathermy Machine (Electrosurgical Unit - ESU)

Selected Equipment: Diathermy Machine (Electrosurgical Unit - ESU)

Selection and Justification

The Diathermy Machine commonly referred as Electrosurgical Unit (ESU) is an

indispensable application specifically in the operating theatre because it is only capable of
severing tissue through the application of high frequency electric current and equally
coupable of coagulation. Unlike other sterilization accessories already applied in most
establishments including autoclaves or filtration systems, the ESU is specialized for use in
surgical activities. Its ability to both incise and coagulate tissue makes it possible for surgeon
to manage hemorrhage and keep a clean surgical field all of which are important factors for
the success of major operations. The ESU has the most benefits in procedures that require
minimal invasions as the device’s accuracy and work rate result in faster healing moments
and lower chances of adverse effects. Moreover, it has several operational modes that include
cutting, coagulation, and blending which enables the surgeons to set the device performance
based on individual surgeries’ requirements and therefore improves the surgical versatility.
Thus, the ESU enhances patient safety and surgical outcomes in terms of tissue manipulation
and blood loss, rendering it a viable surgical tool in today’s practices. Its integration into the
operating theatre highlights the centrality of this technology in enhancing new surgical
procedures and patients’ care outcomes.

Justification:

 Purpose: The ESU helps to incise tissues and coagulate them with high accuracy
which will help a surgeon to control bleeding and perform intricate operations
regardless.
 Exclusivity: In the case of sterilization equipment, the various machines may be
employed in laboratories or clinic while the ESU is specially designed for use in
surgeries thus it can be regarded as part of the OT equipment.
Introduction

The OT is a prime area in hospitals where surgeries are carried out to treat people, increase
their lifespan, and enhance their quality of life. Being a medical facility, the OT houses some
of the most modern technologies that call for optimum skill, quick, and precisely executed
actions. However, among the necessity of the devices that can be found in the OT is the
Diathermy Machine that is commonly referred to as the Electrosurgical Unit (ESU). This
device has become almost indispensable in the operating rooms of today’s hospitals as it
empowers the surgeon to carry out fine and complex movements with reduced risk of injury.
The primary work done by the ESU is precisely dissecting the tissues, and coagulating blood
vessels through the application of high-frequency electric currents that help in sealing the
blood vessels and achieving hemostasis within a short span of time during surgery. This
capability also contributes to improving on crucial matters that relate to surgical
performances in order to reduce on complications that may arise hence improving patient’s
recovery rates (Richtsmeier, A. J, 2020).

Figure 1: Diathermy Machine

It comprises of a generator, an active electrode, return electrode usually the patient plate, and
the control panel. The generator creates high frequency currents which are conducted to the
tissue through the active electrode, the return electrode forms the closing circuit. The control
panel is used to invoke device control where the surgical team can easily change the settings
of the device according to the type of surgery needed for tissue management. These cuts,
coagulation and blend allows the surgeon to control the ESU and its output based on the
specificities of the surgery.

Besides, the ESU plays a vital residual role in the processes of cutting and coagulation, while
also enhancing the speed of the surgical process due to the elimination of such auxiliary
procedures as clamping and suturing. Thus, the ESU increases a surgeon’s ability to manage
bleeding and perform MIS, leading to positive changes for the patient and establishing a new
level of outstanding surgical achievement in the OT.

Figure 2: Components of Diathermy Machine

Components

The primary components of a Diathermy Machine include:

 Generator: Generates fast moving electrical vibrations also known as electrical

current.
 Active Electrode: The name of the device, which the surgeon applies to transfer
electrical energy into the tissue.
 Patient Plate (Return Electrode): Compliments the circuit by taking current from the
patient and taking it back to the generator.
 Control Panel: It has features where the surgeon can set parameters of the devise for
such things as power, mode, and waveform.
 Foot Pedal: They give the handheld control of the device during surgeries and some
other operations.
Working Principle

Principle

Diathermy Machine work on the use of electrical energy that is in the form of heat to sever
tissues or coagulate. This involves the use of flowing high frequency AC through the tissue
structures causing heat as a result of the tissue’s electrical resistance.

Techniques Used

Monopolar Electrosurgery:

 Setup: Engages the use of one working electrode and one ground electrode which is
the patient plate.
 Usage: This type of system is used mostly for cutting and also for coagulation.
 Mechanism: The current in the current control system is defluxed from the active
electrode passing through the body of a patient to the return electrode.

Bipolar Electrosurgery:

 Setup: Uses a double forceps like electrode.

 Usage: Employed mainly in the coagulation, especially in any sensitive areas on the
face and body.
 Mechanism: The current passes between the tips of the bipolar forceps and restricts
the current bearing path to tissue between the electrodes.
Block Diagram

Control Panel Audio Tone

Generator

Isolator Switch
Board Logic Board Power Output
Board

Foot Switch

Power Supply

Mode of Device

The Diathermy Machine, also known as the Electrosurgical Unit (ESU), has several
working modes to fulfill different tasks of surgery, all of which can enhance the usability of
tissue and the control of bleeding. Cut Mode is one of the basic modes; it allows the constant
signal with no intermissions, which is suitable for accurate severing of the tissue material.
This mode is useful in making very fine and clean incisions without producing much heat that
is peripherally constructive to the adjoining tissue meaning very precise operations can be
carried out. It is especially beneficial in operations where accuracy is expected, for example,
operations like neurosurgeries and microsurgeries where tissue’s texture should not be
compromised in any way. The Coagulation Mode uses a pulsed waveform that consists of
bursts of high-frequency current that are released periodically. This mode is specifically used
in achieving hemostasis by coagulating the blood vessels and tissues so as to block them from
resulting in bleeding. And is often employed in operations where blood coagulation is likely
to be a decisive factor, for instance hepatic or vascular surgery. The other advantage
pertaining to the coagulation mode is its ability to manage bleeding and this also helps in
creating a clear surgical site where the surgeon can effectively see and work on
(Christopoulos A, 2017).

Also, the ESU provides a Blend mode, which is a combination of cut and coagulation modes.
This mode comprises shearing and coagulating abilities and is thus useful in operations where
sharp dissection and coagulation of tissues are needed in rapid succession. The cutting mode
helps to achieve optimum performance in cutting and coagulation steps the blend mode
intervenes between the two and minimizes the need of changing between modes and
therefore improves the workflow in operation theatre. The specified means, in turn, can be
flexibly adjusted depending on the characteristics of the tissue and the results expected in the
course of the surgery, so that the surgical staff can achieve maximum results. It is
demonstrated that these different but related modes provide improvement of the surgical
accuracy and flexibility to become truly valuable as a surgical tool in the operating theater
(Cabalag M. S, 2015).
 Figure 3: Modes of Diathermy Machine

Hazards and Safety

The Diathermy Machine (Electrosurgical Unit – ESU) is very useful in a surgical context
and yet comes with the following risks that require measures that will give maximum
protection to both patient and staff. The first possible danger that can be linked to the
utilization of the ESU is that of electric shock with possibilities for the burns in the course of
the procedure. These burns are a result of intentional or accidental contact of the active
electrode with other parts of the body or placing of the return electrode where a lot of current
is delivered. To help avoid this risk, the return electrode must be correctly connected and
anchored firmly to the patient and care must always be taken with the active electrode,
especially when it is not in use. Another major danger is the potential of fire as high
frequency electric current may cause inflammational of flammable items like alcohol used in
antiseptic or drapes used in the operation theatre (Dodge B. E, 2019).

Figure 4: Electrical Hazards of Diathermy Machine

Electromagnetic interference (EMI) is the other concern because the generated high-
frequency currents by the space may interfere with the other medical equipment in an
operating theatre same as the pacemakers or monitoring devices. To avoid the problem of
EMI, grounding and shielding of equipment as well as clearance between the ESU and other
electronics must be accomplished. However, Smoke Hazards which range from respiratory
diseases that may be caused by the tissue vaporization process are other dangers that the
surgeons are likely to face. An example of this hazard is when a patient is on a ventilator; the
smoke evacuation systems and proper ventilation in the operating room reduces this risk
(McKenzie, R. B, 2015).

Preventive maintenance

Periodic checkup the Diathermy Machine (Electrosurgical Unit – ESU) is very important
in order to ensure its well-functioning and safety. Daily maintenance procedures make sure
the device runs smoothly and this minimizes the occurrence of faults during surgery,
moreover the durability of the equipment is greatly enhanced. The pre-use inspections
include simple visual tests of the cables and electrodes for almost any signs of wear and tear
or damages. Any sign of wear tear, splitting and cracking make the cables a dangerous source
of electric shock and hence has to be replaced. Calibration is another primary segment of
preventive maintenance that is often done on a monthly basis or as dictated by the
manufacturer. In this case, dedicated calibration equipment is applied to check whether the
ESU’s output settings are correct and stable, thus delivering the required amount of energy
for cutting and coagulation, which would not affect the surrounding healthy tissue (Feldman
L. S, 2019).

The general recommendations include cleaning and sterilization of the ESU accessories,
particularly the active electrode and the patient plate after each use. This eliminates the
accumulation of biological substance that could hinder the efficiency of the device and
secures aseptic conditions for every affected patient. These components should be cleaned
with approved disinfectants, but it is necessary to observe great caution not harm sensitive
parts. Broad based servicing by a professional mechanic should be done once a year. This
servicing involves a detailed assessment of all the inner parts and any part that shows signs of
wearing or damage is replaced with a new one and software upgrade incase. Technicians also
identify internal problems that an ordinary user may not see and this will ensure the device is
in the best condition (Roy, S, 2021).

Also, the detailed maintenance log should be kept all the time. This log should consist of all
the activities that have to do with the inspection, calibration, cleaning, and servicing of the
equipment to ascertain all the matters that require repetitive tasks in order to detect them and
to ensure that the maintenance schedule is followed.

Common Errors and Troubleshooting methods

The Diathermy Machine (Electrosurgical Unit – ESU), which is used in surgeries, can
encounter numerous types of errors during surgeries; hence, the following guide to the
common errors that doctors need to employ to troubleshoot with the help of specialist
engineers to get the interrupted surgery going again. One regularly occurring question is
where the active electrode is not putting out any output; this is usually due to improper
connections, and bad cables. In solving this problem, one should ensure all the cables and
connected parts are properly connected and examine the cables for any scratches or poor
joints. The cables are therefore required to be replaced so as to bring back order in the
physiological processes. Inconsistencies of the power output are also considered a common
mistake that arises from the calibration problem or a faulty component. To this, it is correct
that recalibration of the device is required in other to have right setting on the output (Nduka,
C. C, 2014).

Some risks are as follows:

If the ESU settings are not appropriate, one may get burnt or if the active electrode touches
the tissue for a long time, there could be tissue damage. To avoid this, it is advised that the
settings are checked before use and that surgical personnel are taught how to use the
appropriate technique. Reduced contact time and power settings can specifically reduce the
amount of tissue damage that occurs. The noticeable error codes on the ESU are frequently
detected that refers to the software or hardware failure. It is necessary to find specific codes
in handbooks to know what to do; in some cases, the user should reset the device, while in
others, it might require consulting the support team and getting professional help. Sparking
or arcing during use may also suggest improper make and material of the electrodes or
insulation being worn out.

If the device will not turn on, then initial steps involve checking that the power IN is
connected, examining the power cable for flaws, and checking the fuse. If blowing of fuse is
the problem then replacing the fuse is likely to solve the problem. Creating and adhering to a
surgery troubleshooting guide in which you jot down certain processes and typical
antidotes can prove to be quite beneficial to the surgical team since it would allow them to
alertly rectify certain circumstances and reduce the interruption of time-sensitive procedures.

Conclusion

This paper focuses on The Diathermy Machine (Electrosurgical Unit – ESU), which is a core
component in an operating theatre as it awards the surgeons a significant tool that enables
them make clean cuts and effectively control bleeding. It also means, knowing its
components and working as well as its potential dangers, surgeon teams can enhance its
effectiveness in order to contribute to patients’ better outcomes. Maintenance and
administration or correction tasks play a role in guaranteeing that the ESU is performing at
optimum levels without posing some risk factors towards the surgeons while in operation.

References

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