Question of the Month with Comment
MedSun: Newsletter #4, May 2006

Question:
We are using electrosurgical units (ESUs) with infants in radiant warmers and are concerned that the patient temperature probe used with the radiant warmer might provide an alternate path for the ESU’s radio frequency energy and lead to a burn at the site of the temperature probe. Are there recommendations from ESU or radiant warmer manufacturers about this, or any standard of practice that would provide a reference on the subject?

Comment:
One of the standards of practice for ESU use is provided by the Association of Perioperative Registered Nurses (AORN). The organization’s “Recommended Practices for Electrosurgery” appears in its AORN Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc., 2005). While there is no reference to the use of ESUs with radiant warmers, the guidelines state that “Patient monitoring electrodes (e.g., electrocardiogram, oximetry, fetal) should be placed as far away from the surgical site as possible. Alternate pathway burns have been reported at electrocardiogram electrode sites and temperature probe entry sites with ground-referenced electrosurgery units.” While modern ESUs are not ground-referenced, some older models may be. One should additionally be on the lookout for the radio frequency from the ESU interfering with the temperature regulation of the radiant warmer; in other words, the temperature display may fluctuate when the ESU is activated.


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