王美芳制作_电外科安全讲座.pptVIP

六、电外科安全注意事项 单极电刀使用注意事项 使用含酒精的消毒液消毒皮肤时，应避免消毒液积聚于手术床，消毒后应待酒精挥发后再启用单极电刀，以免因电火花遇易燃液体而致患者皮肤烧伤。气道内手术使用电刀或电凝时应防止气道烧伤。肠道手术禁忌使用甘露醇灌肠，肠梗阻的患者慎用电刀。 负极板尽量靠近手术切口部位（但不小于15cm），避免越过身体的交叉线路，以便使电流通过的路径最短。 腔镜手术使用带电凝功能的器械前，应检查 绝缘层的完整性，防止漏电损伤邻近脏器。 双极电凝使用注意事项 双极电凝使用时应用生理盐水间断冲洗或滴注，保持组织湿润、无张力及术野清洁，避免高温影响电凝周围的重要组织和结构，减少组织焦痂与双极镊或钳的黏附。 电凝时，用湿纱布或专业无损伤布及时擦除双极电凝器械或镊的焦痂，不可用锐器刮除，以避免伤头端或镊尖的合金材质。双极电凝器械操作时应动作轻柔，在固定双极镊尖时，两尖端保持一定距离，避免互相接触而形成电流短路或外力导致镊尖对合不良影响电凝效果。双极电凝 器械清洁后应在头端或镊尖套上保护套。 超声刀使用注意事项 术中清洗超声刀刀头，将刀头张开完全浸没于生理盐水中，利用脚控或手控开关启动超声刀清洁刀头，避免与容器边缘接触。 超声刀工作时禁用手触摸，并避免长时间连续过载操作；不能闭合刀头空踩脚踏板或用超声刀头夹持金属物品及骨组织；由于超声刀闭合管腔是永久性闭合，需确认闭合的组织类型是否适合。 * Why do surgical team members sometimes get shocked while holding a hemostat? A hole in their glove, frequently blamed for this occurrence, is actually a result of the shock. The current applied to the hemostat that is clamped to the bleeding vessel will travel to the tissue, seeking the return electrode and thus attempting to complete the circuit. As the tissue is desiccated, the resistance rises. When the resistance reaches a point where the path of least resistance becomes the person holding the hemostat, the current will take that path. Scrubbed members of the surgical team frequently are touching the patient and are therefore putting themselves in circuit. The manufacturers of electrosurgical generators do not recommend that surgeons use the technique of “buzzing the hemostat”. However, it remains a commonly employed method of achieving hemostasis and there are techniques that can reduce the potential for being shocked. The techniques shown are for stainless steel electrodes. Helpful hints: Do not “buzz the hemostat” with a needle electrode Do not lean on the patient, the table, or the retractors while buzzing the hemostat Activate cut rather than coag Firmly grasp as much of the hemostat as possible before activating Buzz the hemostat below hand level Activate the generator after the instrument makes contact w