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Delivering safety and comfort in theatre with reusable patient return electrodes

Naby Nassef
Senior Technician
Cromwell Hospital

Advances in technology have led to electrosurgery becoming  safer. But many serious burns, especially in relation to  passive or return electrodes, continue to occur. The primary  purpose of the return electrode is to remove the current  from the patient and return it to the generator, which  completes the electrical circuit and prevents heat build up  and subsequent burns to the patient. However, the risk of  burns is increased if the return electrode contact area is  minimised, creating an area of high-current density that can  cause burns to the patient.

In 1981, return-electrode contact quality monitoring (RECQM)  was developed as a way to safely disperse the electricity  from the body and help prevent pad-site burns. The RECQM  circuit measures the quantity and quality of the tissue in  contact with the pad. If an unsafe pad contact is  encountered, the generator goes into alarm mode and switches  off. Although an improvement, these small adhesive  “peel-and-stick” pads still pose the possibility of heating  beneath the pad leading to a pad-site burn.(1)
In addition to the potential heat buildup, disposable  peel-and-stick electrodes can also pose additional risks  such as skin irritation, skin tears and the problem of where  the pad can be safely applied. For example, guidelines from  the Association of periOperative Registered Nurses (AORN)  state: “Return electrodes should not be placed over bony  prominences, scar tissue, hairy surfaces, areas distal to  tourniquets, and on pressure points as this can impede  electrosurgical return current flow.”(2)

Providing patient safety and peace of mind
Cromwell hospital is an internationally recognised centre of  excellence and has earned a reputation in the UK as the  country’s most prestigious and technologically advanced  independent medical and surgical care facility. Renowned for  its liver, cancer, cardiac and neurosciences specialties,  Cromwell houses four operating theatres –  including a  paediatric theatre – and offers in-vitro fertilisation (IVF)  and fertility treatment programmes.

For electrosurgical procedures at Cromwell, patient safety  is a foremost priority. To help ensure the safety of its  patients during electrosurgery, Cromwell is employing the  uniquely designed Mega Soft(TM) (Megadyne) patient return  electrode featuring capacitive coupling. This provides the  hospital staff with the ease of use associated with a  capacitive pad, and an innovative design that provides  patients with both comfort and safety.

Capacitive coupling can be defined as the flow of current  through a capacitor. A capacitor is essentially two metal  plates separated by an insulator. During monopolar  electrosurgery the patient is very conductive and can be  viewed as one plate in the circuit. The other plate in the  circuit is the conductive material found within the  capacitive pad. With the innovative patented design  providing a higher impedance per area, a level of safety  equal to or exceeding that of monitoring style gel pads (ie,  RECQM) can be achieved.

The Mega Soft reusable patient return electrode pad is  essentially a large, single conductive material sandwiched  by two sheets of pressure reducing Akton Polymer. The  conductive portion of the pad is the other plate of the  capacitor. Due to the oscillating high-frequency nature of  the current flow, current flow is induced from the patient  to the pad, safely exiting the current from the patient to  prevent heat build up under the pad and the possibility of a  burn. The pressure reduction portion of the pad also helps  to reduce the formation of pressure sores.

It provides the convenience of a two-in-one product that  benefits our patients and staff alike – but mainly our  patients. We have the peace of mind that we are providing  the safest service and care possible for our patients.

Enhancing patient comfort
Every patient attending the operating theatre will at some  stage be at risk of developing a pressure sore. Pressure  ulcers are defined as lesions on any skin surface that occur  from unrelieved pressure and result in damage to the  underlying tissue.

Prevalence studies carried out at one UK teaching hospital  found that between 40% and 64% of patients with a pressure  ulcer had been to theatre and had major surgery.(3) In the  USA, more than €1.02 billion is spent annually treating  pressure sores. An extensive study – surveying 104  facilities and 1,128 patients after surgery lasting at least  three hours – identified a rate of 8.5% of all surgical  patients developing pressure ulcers.(4)

The surgical staff at Cromwell view pressure relief as very  important in surgical procedures. The stress placed on  pressure points during a lengthy procedure can put patients  at a higher risk for pressure sores. We have found that an  internal pressure-reduction pad decreases the pressure,  shear and friction during lengthy surgical procedures to  help prevent the development of pressure sores.

Saving time and resources
Cromwell’s surgical staff are benefiting by saving a  significant amount of surgical prep. Time spent shaving and  locating well-vascularised placement sites without bony  prominences, scar tissue, hair, metal prostheses, tattoos or  areas distal to tourniquets and pressure points is  eliminated. As a result, there is more time to spend on  providing worthwhile patient care.

Additional time can also be saved in the operating theatre.  Procedures are often delayed when the surgical team stops as  a nurse works around the surgical table to identify a site  to apply the sticky electrode pad, and then redrape the  surgical area. With Mega Soft there are no delays. Patients  who are placed onto the return electrode are grounded and  ready for electrosurgery at any point if it becomes  necessary during the scheduled procedure.

Cost-conscious and environmentally friendly
A reusable technology can also help to improve the  environment — and a hospital’s bottom line. It eliminates  the expense incurred by throwing out peel-and-stick return  pads. In our operating theatres, eliminating peel-and-stick  pads has significantly reduced our waste disposal budget and  it has made our practices better for the environment.

A tradition of excellence
Our goal at Cromwell is to make people better in an  environment that is safe and caring, with London’s leading  doctors, state-of-the-art equipment and highly trained  staff. This year, we celebrate 25 years of providing  outstanding patient service and care. The reusable patient  electrode pad is just one of the indispensable,  state-of-the-art technologies helping us to consistently  deliver a high standard of excellence for our patients and  staff.


  1. ECRI. Higher currents, greater risks: preventing  patient burns at the return-electrode site during  high-current electrosurgical procedures. Health Devices  2005;34:273-87.
  2. AORN. Standards, recommended practices, and  guidelines. Denver: AORN; 2006.
  3. Dealey C.Monitoring the pressure sore problem in a  teaching hospital. J Adv Nurs 1994;20:652-9.
  4. Aronovitch SA. Intra-operatively acquired pressure  ulcer prevalence: a national study. Adv Wound Care 1998;11  Suppl 3:8-9.