electric cautery

hi all.    anyone have surgery using electric cautery with a defibrillator?  sadly i have a malignant melanoma and surgeon will be using cauterization. talk of grounding, magnets,  patches etc.   doesnt sound easy....  thanks!

 

 


14 Comments

Where is your Melanoma?

by donr - 2018-11-25 02:51:52

Makes all the difference in the world.  If it is close to the PM, it's a problem.  If it's far from the PM/ICD site, iot's a piece of cake.

 

Tell me & I'll give you an ansrt.  MD daughter just bought a Bovie.  I've read the instructions that come wityh it.  Haver some insight to the mystery.  Will be end of week before I can answer - going on a short, no web  - trip.

Donr

Cautery

by IAN MC - 2018-11-25 06:06:12

Last Year I had a basal cell carcinoma removed and cauterized. It was just below my right ear, about 10 inches from the pacemaker site on the left.

The dermatologist was quite nervous about doing it and used the absolute minimum level of cauterization to do the job. I am alive to tell the tale ( I think ) and did not experience any problems.

I look forward to hearing from Don when he unearths more info,

Best of luck

Ian

to ian and donr

by capecod - 2018-11-25 08:00:59

i cant think of 2 guys id rather have heard from on this site....

the melanoma is on right chest, just below neck, about 6-7 inches from device. my dermatologist sent me to a surgeon and i see him on tuesday.  i live on the cape and my electrophysiologist and cardiologist are in boston. im beginning to think i should head there.....i. already am a walking basket case!

don, woild love to hear more from you.

thank you both. 

patty

Bovies

by donr - 2018-11-25 12:57:04

Daughter bought the smallest/cheapest Bovie available - $2500 

Here's what I recall freom readintg the instruction sheet:

 

They want you to place the ground sheet as closwe to the site as possible. That means for you on the RIGHT SIDE as claos to the lesion as possible.  I assume your ICD is on the LEFT sidfe.  Run the device at the LOWEST possible current level.  They are adjustable from 10 - 50 amps of current.  Daughter usded hrers at 13 amps for a similar lesion & ir worked fine - that was set on "Coagulate"  The 50 amp setting is for cutting BONE, so dont worry about getting too much current.  He/she shopuld work slowly & in short bursts of current.  He probably has an OR type thay hasd a fot switch & tons o0f bells & whistles.  

The question yopu sould ask is "Have you ev worked around an ICD before?"  It surgeon gets insulted/ irritated, politely excuses  yourself & gho elsewhere.  Knowing you are concerned should be enough for them to discuss it w/you.  I asked that question of an orthopod who was working on my right foot & he had NEVER thought about it beore when I asked him to put the ground return on my right thigh.

 

They will p0probbly put a magnet on your ICD to protect you from any spurious problems.  BTW: take the latest print out of your download & verty strongly request that a teech check you when finished to insure that the settings have NOT changerd.  Talk ro Grateful Heart about this issue.  It is a FAIR, RATIONAL request.  Before bellluv surgery I took mine to the OR & handfedf them to the ANESTHESIOLOGIST IN THE HALL OUTSIDE THE ROOM.  sHE WAS SOMEWHAT TAken aback, but they complied w/ my request.

You will bne fgine if you do all this - it will rest your mind.

No vacation - Appt w/ GI Dr about results of colonoiascdopy - which came out fine last month.

Donr

grounding

by capecod - 2018-11-25 13:36:27

don

such good info....thank you. ihave a couple questions... is there any electric current running throigh body during the procedure?  i thought bovie heated utensil that was placed on area?  radio waves? think im confused...so you do need a grounding,pad?

ive read that a device rep, in my case st jude, should be there to reprogram device?  so reprogramming, turning off switches prior to procedure, and  placing the magnet are done simultaneously?   do i understand that the magnet prevents the dfibrillator from seeing heartbeat so as not to give a shock?   this may be totally wrong on my part......dont feel you have to unravel me....im sure ian will take care,of that😘

youve given me great advice.....hopefully this will be resolved this week. i will contact grateful heart also  

many thanks....and best to you with your appointment

Wow!

by donr - 2018-11-25 18:34:50

lot of good questions,  I didn’t think last msg went out.  Got  a note that pic timed out.  Then here I find the whole thing in all it’s misspelled glory.  

There are two kinds of Bovie- one that is battery powered & generates heat by electrical resistance to a direct current from a couple AAA batteries.  Portable, self contained in a cylinder not much bigger around than the batteries.  Notorious for batteries dying during long procedure.  You better have 2 of them handy when you start .  Gets red hot at microscopic tip when activated.  Will either cut tissue or coagulate blood.  Not particularly elegant, but for simple skin procedures, it works fine.  Till the batteries die mid procedure. (Don’t ask me how I know!).   BYW these cost about $10 each & tey are

 

worth all

More wow

by donr - 2018-11-25 18:48:41

What you pay! 

Then there is the OR variety.  $2500 for the cheapest.  Bovie is the brand nam for the top of the line item, but they apparently sell them under medical supply house names (private brannds).  Anyway, these devices are also called Bovies- like Band Aids & Johnson & Johnson.  

These devices generate heat  by using  an    RF current.  RF. Because there is greater energy for the same Amperage.  IIRC, our device can be controlled from 13 - 50 amps.  At 13Amps it cuts or coagulates blood- rapidly- or cuts & coagulates as it goes.  At 50 Ps it cuts bone!.  So there is a lot of flexibility avabile.    These work 2 ways monopolar or bipolar.  Bipolar works like an auto spark plug. The RF current arcs across

Electrocautery

by Grateful Heart - 2018-11-25 19:32:09

Best case is to request a device rep for the day of surgery.  They can check your device before surgery....and after.... to make sure no settings have been changed.  They will turn off your defib for surgery.  They will put external defib pads on you.....just in case it is needed.  It's an extra precaution but don't even think about it....it's just a safety measure.

Yes, bring a copy of your last settings with you as Don said...so you (and the rep) know where your settings were before the surgery. 

When I had a hip replacement, I asked the anesthesiologist (she was very nice) where she was putting the ground pad and she said on my back...right behind my CRT-D.  I said no...my device is right there...I don't want it shorting out.    She asked the device rep where to put it and he said that is not his expertise.  So I told her to put it on my opposite lower back (it was a hip replacement).  The same anesthesiologist was there for a prior surgery I had a few years before and we went through the same process at that time.  I told her she was my  anesthesiologist once before and she went and looked it up....came back very happy that she found it in the notes from the previous surgery.  That told me that they don't deal with this very often (at least where I live)....even though they say they do.  Originally they wanted to put a magnet over it......no thank you.   

I have one lead that is unipolar after a lead revision.  Unipolar leads are more sensitive so cautery and EMI's can be more of an issue.  So in my case a unipolar lead does not return the signal to the pulse generator via a metalic conductor or the lead. Instead, the unipolar lead returns the pulse to the generator by way of tissue and body fluids.  This most likely does not apply to you.

Talk to your docs but from your original post re: grounding, magnets,  patches etc., it sounds like they are on top of it. 

Good luck and keep us posted.  Any questions just ask here or PM me if you like, but Donr is much more informed than I.

BTW, some people go through surgeries with no issues but I choose not to take that chance.  I woke up in the middle of a colonoscopy a few weeks ago....no joke...just in time to see a polyp.  I did not have a rep present, the doc said I didn't need one or medical clearance so I just went with it.  I should have went with my gut.  (No pun intended).  I am now having a lot of PAC's or PVC's or something.  I don't know if it changed the settings.  I find I am tired all day now and doze off in the chair at 6PM....I never do that.  I go back to my EP nurse soon so I'll find out then but something doesn't feel right. 

Grateful Heart

to grateful heart

by capecod - 2018-11-25 22:13:50

thank you for responding! your advice and support is appreciated.sounds as  if you have had numerous experiences. you mentioned  that you didnt want a magnet....why is that?  

i have an appointment with the surgeon here on the cape on tuesday and will pose questions that you, don, and ian have suggested. my boston doc would like to talk with him. depending on the result of that conversation i will make my decision. lots to process.  i like the sound of the bovie that don mentioned.....less current traveling through my body .... i think ....

ill let you know.....many thanks. 

My last wow- maybe...

by donr - 2018-11-25 23:15:01

I am doing this while riding in a car on “”Pothole Interstate”.   This will be the third time I’ve typed it.  Where goes....

OR Bovies work in 2 modes - Unipolar & Bipolar.  Bipolar first.  Bipolar works like like an auto spark plug.  RF current goes out through one half of the electrode & returns through the other half.  Nothing flows through the body.  An arc forms at gap that is very hot.  That heat does the job.  On to Monopolar.  Here the current goes out through the electrode & returns though the body.  An arc forms at the electrode where there is a volume about the diameter of a wooden pencil lead.  For thT small volume, that’s a pot load of current, so it’s pretty darned hot!  We have to control that heat.  Here’s how:  a gazillion electrons come roaring off the electrode.  They all have the same charge, so hate one anothers’ Guts, do quickly spread out like spokes on a bicycle wheel.  Now to the ground plane, about 3x6 inches  (18 square inches).  Spread 13 Amps out over 18 square inches & the current density drops to a small  number- small enough that you don’t get burned,   Now the challengr- to visualize  what happens when you put input & output together.  Back again maybe for the last time.

visualize the ground plane as  the rain in Spain falling mainly in the plain;

 In short  it’s perpendicular to the plane.  Now go back to the source &  visualizie it as Fointain spraying straight up.  All the droplets go up, arc over and fall earthward .  Imagine them now such that the fountain sprays toward the    ICD w/ the ground to its rear.  To keep the ICD out of the current field k a certain amount of space.  The distance to the ground plane  determines that space.  A properly placed  plane - most likely on the rib cage- will confine all currrent to that small space between the Bovie tip & the rib cage.  Put the plane anywhere else  further away & watch thee area of the body affected.    Let’s go to the extreme  & place i it on the calff.  Now the current spreads  across the width of the torso till it all comes together  where the thigh meets the torso. 

Mall this, Patty, to  show that current does NOT  flow everywhere ,.

I read Grateful Heart’s comment several hours ago.  She wrote a great comment for you-take it to heart .  Finally I’m done.  Hope I helped.  My analysis is based on an introductory chapter on electromagnetic field configuration in “ Electromagnetic Theory, “first edition, by some geek named Schelkunovthat is what my memory from 1961 tells me. Dont

 

 

Ian, would you

by donr - 2018-11-26 01:57:43

...to join me in Patty’s living room to discus this subject?  Think it would devolve into a fist fight?    

In the  FWIW Dept, I have run into several hosp’s Using your system of pm clinics.  Mixed bag so far .  Depends a lot on the tech’s involved.

Frank & I agreed years ago that EP’s need a minor in some aspects of EE, especially field theory.  A basic year long course would do it.  He was an instrumentation specialist.   I was a field type.  My hardware  background was weak.’

donr

donr, ian, grateful heart

by capecod - 2018-11-26 12:01:03

wow!  don, i think i get the bovie now!  thanks for lead info grateful heart....and info on pads (see my message above)....as you can all tell, i am very anxious!  but you have been great!  ill let you know ....

don, you and ian are welcomed to spar anytime in my living room...😌

 

Magnets

by Grateful Heart - 2018-11-26 13:08:13

They want to use magnets instead of a device rep.  At least twice a rep has showed up and told the nurse they could just use a magnet and they didn't need him...he could leave.  I had to tell him the doctor wanted him to stay since I had problems in the past.  

One even called the doctor right before a procedure and asked if they really needed him.  The doctor said yes....they want you here.  He showed up and still tried to leave.  Just what you need right before surgery.  I had to get the Cardio and nurse involved for last major surgery.  I told them all of this and I guess they read them the riot act.  The rep that showed up did not try to leave.  I don't think most people have this problem though....go figure.

So I would definitely have your Cardio and the surgeon speak...just so they are on the same page....and to ease your mind.

It stinks but it's normal to be nervous pre-surgery.  I just tell myself it has to get done and say a few prayers.  I'm still here so it works for me...lol.  There is so much advancement in the medical field now.

I hope all goes well.  You got this!

Grateful Heart

GH, Ian, CC..... tequiresm

by donr - 2018-11-27 00:41:22

I recall being in 2 ER’s being downloaded by a hosp employee who was one of Ian’s type device specialists.  One was this past. Fri night while I was being checked out for pneumonia  ( caution paid off -caught it before it took hold.  At 82 you don’t take chances!). It was after 2400 & the place was empty-unusual, & we chatted more than a bit.  I was  impressed!  Nice part- he was there on duty & answered to the hosp.  Didn’t have to be called in.  Really interesting part was that hosp has ZERO cardiac presence.  Town is small- 15,000 pop.  They do have 3 board certified ER  docs.  Remains to be seen how good they are.  They have had them before & a big city hosp ego caused grief.  As I’ve preached,  rural medicine requires a different mindset - stabilize & transport.   With the advent of chopper evac, rural now means more than 50 miles to  specialty support & still get it w/I the Golden Hour.  I’m pretty darned proud of M D Daughter,  she did 15 yrs of night ER’s & never lost a heart attack victim.

Second hosp was where I had my recent colonoscopy.  My GI doc will not do them out from under cardio support for PM hosts or leaky valves.  While sedated my heart did something wired & the ER was but 100 feet away.  Again download was immediate & by one of Ian’s Chums.  We  chatted a bit about his background & training.  Impressed.

GH, this PM support should solve your problems.

Donr 

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