What is "diathermy" (re NPL 11.8)

RE: What is "diathermy" (re NPL 11.8)

Malcolm Ness — Tue, 14 Mar 2017 19:37:46 GMT

We had a Valleylabs FX unit in each of our theatres and used them for almost everything. A single electro-scalpel allows cutting or coagulation. The electroscalpels are nominally single use but could be gas-sterilised and re-used. Plenty of generic suppliers of the electroscalpels and the necessary return electrodes.

The initial investment is significant though there are loads of machines available re-furbished and affordable. In theory, wounds made with this kind of electrosurgery heal more slowly than scalpel incised wounds but the speed and easy control of bleeding make for quicker, slicker surgery which appears to compensate, or more, for any theoretical wound issues. There is a dedicated bipolar option which we used for anything in or around spine or brain.

RE: What is "diathermy" (re NPL 11.8)

Beats — Tue, 14 Mar 2017 19:17:56 GMT

Thanks Chris, that's very helpful.

I'm sorry about the stars this thread has attracted. I'm not sure if it's the same person does all the starring for everyone's discussion threads as I started this thread and appreciated the responses and was not the person to "rate" them with stars. Is it possible to start a discussion thread without stars next time I'm starting one to keep it a bit friendlier?

RE: What is "diathermy" (re NPL 11.8)

ChrisBVSc — Tue, 14 Mar 2017 17:40:41 GMT

We've got a mono & bipolar unit, I use it a lot - at least weekly and often more. Bipolar is great for any surgery where you're likely to come across lots of oozing vessels as you can quickly and easily stop any haemorrhage and move on, and I use monopolar a lot for excising small skin & gingival masses. I think it's one of those machines that you can find more use for as time goes on, and I definitely find it a handy bit of kit to have on standby.

This link gives a good explanation on how it works if you're interested:

https://www.asit.org/assets/documents/Prinicpals_in_electrosurgery.pdf

By the way I'm not entirely sure why my previous response got one-starred, seems a bit odd when all I did was share my experiences of how this terminology can be confusing. If anyone wants to dispute or debate what I've said then post a proper response so everyone can learn something. It doesn't exactly encourage active participation in a forum like this when you get that kind of response with no explanation!

RE: What is "diathermy" (re NPL 11.8)

Evelyn Barbour-Hill — Fri, 10 Mar 2017 23:34:46 GMT

If you go for that make I'd think the 120 entirely adequate, and that looks really inexpensive.

BUT it operates at 600kHz and the optimum is considered to be 4MHz. Much less heating of tissues around the site: forget all the old prejudice against "diathermy". Which means Ellman, I think, which means greater expense.

If you want to use bipolar, don't buy the ripoff "bipolar adaptor": if you're handy with a soldering iron you can knock up exactly the same for a couple of pounds.

I use it daily. Most of all for all incisions, almost all of them with the pure cutting waveform. Drag-free incisions! Great for skin plasties. Sometimes on the cut-coagulate setting. Not often for coagulation alone. Use it to sever the uterus or vagina, between two forceps, in spaying (not as a substitute for ligation!!!) i originally bought it for dental and oral surgery, but oddly enough I now choose a scalpel for incisions of gingiva. The electro is great for whipping off hyperplasia though, or for gingivoplasty of pockets (but I don't do that technique so much now).

Maybe it's me, but I found it disappointing for ablation of distichiasis lashes.

Mine also has a fulguration setting, which of course I have never used. I hope nobody does that these days!

RE: What is "diathermy" (re NPL 11.8)

Beats — Fri, 10 Mar 2017 20:04:28 GMT

Thanks for all the replies, it's been educational

For those more savvy on the technical stuff, can I ask whether this looks like a reasonable spec for use in veterinary clinic and if £700 is what would roughly expect to spend to tool-up with "diathermy"?

http://www.quirumed.com/en/catalog/product/view/id/68073/s/electrocautery-for-monopolar-and-bipolar-surgery/category/2563/?sid=68072

Also do you use it daily/weekly/monthly/less and what are main indications/uses in your opinion/experience?

Thanks in advance

RE: What is "diathermy" (re NPL 11.8)

ChrisBVSc — Fri, 10 Mar 2017 16:32:19 GMT

Radiosurgery generally refers to the use of ionizing radiation - only mentioning that because I've come across clients with hospital experience panicking after hearing we might use radiosurgery, when in fact we use an electrosurgery machine. (The only 'radio' part of it is the fact is uses radio frequency AC current).

Electrosurgery is what most people I know tend to mean when they talk about "diathermy" i.e. the typical unipolar/bipolar surgical units that use high frequency AC current, and this is most likely what the NPL is talking about. Whether you can get away with an old electrocautery device/glorified soldering iron, I'm not entirely sure!

RE: What is "diathermy" (re NPL 11.8)

Evelyn Barbour-Hill — Fri, 10 Mar 2017 12:27:44 GMT

[quote user="robloxley"]

[quote user="Beats"]She thinks that a plug-in-and-tip-heats-up device hiding in a cupboard (which I last used to solder the pulse oximeter) might count[/quote]

Depending who you speak to (as always with NPL) it will count

[/quote]

Then somebody at NPL is pretty ignorant.

Moving on, cautery is only one of the uses of diathermy (electrosurgery, radiosurgery) and in my opinion is not its most useful feature.

RE: What is "diathermy" (re NPL 11.8)

Rob Loxley — Fri, 10 Mar 2017 08:46:44 GMT

[quote user="Beats"]She thinks that a plug-in-and-tip-heats-up device hiding in a cupboard (which I last used to solder the pulse oximeter) might count[/quote]

Depending who you speak to (as always with NPL) it will count

[quote user="Beats"]but can arrange brief experience in another clinic to cover the skill if required (or the demonstration of a try-before-you-buy unit in-house perhaps)[/quote]

If you feel the NPL should aim to equip nurses with skills for their future rather than just a tick-box exercise, I'd do this

RE: What is "diathermy" (re NPL 11.8)

Beats — Thu, 09 Mar 2017 23:03:51 GMT

[quote user="Emily Rainbow"]I think those are thermalcautery rather than electro as they heat up rather than pass an electric current through stuff.[/quote]

I thought (from my brief google, and apparently supported by OED) that "thermo-cautery" simply meant cautery with hot object (as opposed to eg chemical), while "electrocautery" meant cautery where electricity (as opposed to eg a poker from a coal fire) created the heat, either directly in a filament that then is applied to tissue or via electrical current applied directly to tissue?

Further thoughts from the word wizards?

RE: What is "diathermy" (re NPL 11.8)

Evelyn Barbour-Hill — Thu, 09 Mar 2017 22:44:20 GMT

[quote user="Beats"]She thinks that a plug-in-and-tip-heats-up device hiding in a cupboard (which I last used to solder the pulse oximeter) might count, [/quote]

No, that's thermocautery and doesn't count at all (quite apart from being forty years out of date )

I think whoever wrote "diathermy" must be referring to electrosurgery. (Even that is some 25 years out of date, the effect achieved by good modern units employing the optimum frequencies being better referred to as radiosurgery )

About 20 minutes should be ample training.

RE: What is "diathermy" (re NPL 11.8)

Michael Woodhouse — Thu, 09 Mar 2017 22:39:15 GMT

No one would ever know, use your ancient burner.

RE: What is "diathermy" (re NPL 11.8)

Emily Rainbow — Thu, 09 Mar 2017 22:21:30 GMT

I think those are thermalcautery rather than electro as they heat up rather than pass an electric current through stuff.