Electrocautery Periprocedural Care

Updated: Oct 06, 2015
  • Author: Mohsin R Mir, MD; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Patient Education & Consent

The steps, risks, benefits, possible complications, and alternatives of electrocautery should be explained to the patient. Consent from the patient or a legal patient representative must be obtained prior to the procedure.

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Equipment

Equipment includes but is not limited to the following:

  • Surgical mask with eye protection
  • Gloves
  • Antiseptic solution
  • Fenestrated drape
  • Lidocaine 1% with or without epinephrine
  • Syringe
  • Injection needles
  • Gauze, 4 x 4 inch
  • Dental rolls
  • Electrocautery (thermal cautery) unit/disposable pen
  • Electrode tips
  • Sterile hand sheath
  • Smoke evacuator
  • Marking pen
    Electrocautery device Electrocautery device

Electrocautery devices can be in the form of disposable battery-powered pens or line-powered thermal cautery units.

Line-powered thermal cautery units

Line-powered thermal cautery units are capable of producing a range of temperatures, adjustable by the operator to achieve the desired effect on the tissue. They are better able to maintain a constant temperature during use as opposed to battery-powered cauteries, which drop in temperature upon contact with tissue. Line-powered thermal cauteries cost between $600.00-900.00, which typically includes various interchangeable disposable or reusable electrode tips.

Disposable battery-powered cauteries

Disposable battery-powered cauteries are sterilely packaged for single use. Each box typically contains 10 individually packaged cauteries with noninterchangeable tips and cost around $130.00. Each cautery produces a fixed temperature that is not adjustable. Reusable battery-powered cauteries are also available and are commonly sold in kits that contain high-temperature and low-temperature cautery handles, battery replacements, and interchangeable tips. These products typically cost less than $100.00.

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Patient Preparation

Preoperative care for electrocautery involves identifying and eliminating potential safety hazards to the patient and operating team. A thorough patient history and physical should be performed to determine the patient’s general medical condition; to identify any risk factors for excessive bleeding, susceptibility to infection, or poor wound healing; and to note any allergies to antiseptics, anesthetics, and dressings, among others.

The treatment team wears gloves and masks, and smoke-evacuation equipment should be available. The lesion and the area surrounding are cleaned with nonalcohol solution such as chlorhexidine or povidone iodine. For malignant lesions, marking the clinical border of the tumor may be useful, as anesthetics can blur the margins. If alcohol is used, ensure that the area is dry before beginning the procedure.

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Anesthesia

Local injection of 1% lidocaine is typically used prior to in-office procedures. Lidocaine with epinephrine can be used for vasoconstrictive effects if injected 15 minutes prior to the start of the procedure. Depending on the tolerance of the patient, some procedures, such as removal of acrochordons or small angiomas, do not require anesthesia. [18] Alternatively, instead of lidocaine, liquid nitrogen can be used as cryoanesthesia prior to procedures. [18, 19]

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Monitoring & Follow-up

Superficial wounds are allowed to heal by secondary intention with daily cleansing and application of petrolatum. The wound can be covered with a protective dressing or bandage. Larger wounds can be covered by Telfa­ sheets and secured with paper tape. [1]

Deep wounds are sutured and covered with a nonadherent dressing. A pressure dressing can be used to decrease the risk of bleeding during the first 2 days. [6]

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