Single-use patient return electrodes should be used as intended; meaning that they should only be used once and then discarded. Trying to reuse the pad could cause it to not adhere properly to the skin of the individual.
Dispersive electrodes should be a proportional size to that of the patient it is being used on.
That means that an infant will have a much smaller pad than a full size adult. Pads should not be altered by way of cutting or folding to fit the patient, but rather one that is specifically made for that specific size should be used.
Using as large a dispersive electrode as possible helps reduce the concentration of the current, which also reduces the risk of patient injury. Before personnel use the equipment on an individual there are a few things they should check.
They should make sure that the manufacturer's expiration date has not passed, and if it has that the pad is discarded. The package containing the electrode should be sealed until immediately before use, at which point the package may be opened by authorized personnel in a sanitized environment.
The disposable pad should be assessed for any flaws, damage, discoloration, dryness, or lack of adhesives. If any of these problems are present, the materials should be discarded so as to prevent any injury or failure during the procedure.
A nurse should ensure that the skin of the patient where the adhesive is being placed is clean and dry. This area should be on a muscle mass as close to the actual surgical site as possible.
It should be placed on a muscular area rather than adipose tissue because muscle is a more effective conductor of electricity. Single use electrodes should not be placed over a bony area since bone is also more resistive.
Other areas on the body that should be avoided include skin with scar tissue, hair, weight-bearing surfaces, potential pressure points, and areas that are distal to tourniquets. Areas of the body with fatty tissue, tissue over bone, scar tissue, and hair can interfere with the electrical current flow.
This can lead to overheating the tissue and causing burns to the skin of the patient. Hair should be clipped or shaved if it interferes with the electrical flow.
Many burns have been caused by electrodes being placed over hairy surfaces and interfering with the flow of electricity. Any areas of the body with metal prosthesis should also be avoided.
The dispersive electrode should not be placed on top of a tattoo either since many inks contain metallic dyes. Such placement may cause overheating, which may result in burns to the skin of the patient.
Personnel should ensure that the electrode is placed evenly across the area of the skin on which it is adhered to. Improperly placing it on the skin in a way where it does not adhere properly could result in potential problems during the procedure.
These problems may include, but are not limited to, tenting, gaping, and moisture. To fix an improper adhesion the nurse should remove any hair, lotion, oil, moisture, or prep solution form the area.
They should then change contact sites and apply a new pad; discarding the used one. No tape should be used to hold the dispersive electrode in place as this may cause pressure and increase the concentration of the electrical current.
The patient should be placed in their final position for the procedure before adhering the electrode to their skin. Moving the patient after it is attached may disrupt the contact and cause problems such as tenting, gapping, or moisture collection.
Any of these problems may lead to patient injury or other complications during the procedure associated with improper contact to the skin. If there are any questions as to where to place a patient return electrode, the nurse should consult a doctor and the manufacturer's directions.
Author Resource:-
Tommy Greene has worked in surgical equipment sales for the past 15 years. He has great advice and information on Electrosurgical units.
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