2 bovie pads for obese patients?

Specialties Operating Room

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Specializes in Operating room..

OK...I was always taught to place 2 bovie pads on all patients over 300 pounds...something about impedance (blah, blah, blah)...well I am PRN at a new facility (different state too) and they have never heard this. The Covidien rep acted like I was nuts. I found something from Covidien stating that obese patients should have an extra pad but nothing terribly informative. I want to do what is best for my patients and try to provide some helpful info at the same time but if my Covidien rep doesn't even know what I am talking about how am I supposed to do this. I need hard evidence. Anyone have any out there? Thanks!

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Specializes in OR, Nursing Professional Development.

Never heard of this. Our bovies only have one port for a grounding pad, so what exactly does a second one do if it's not connected to anything?

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Specializes in Operating room..

Yes...there is an adapter...you plug in two pads but it connects to the one input plug. Covidien sells this adapter.

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Specializes in Peri-Op.

We did a lot of bariatrics at my last two facilities and we never used two pads. PTs were up to 1200 lbs. gastric bypass, sleeves and bands.

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Specializes in Operating room..

I will post the newsletter from Covidien I found that stated cases with a high potential for "impedance" (obese patients was listed) should use 2 pads later.

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Specializes in Operating room..

I found it!!! It was in an AORN journal, I made a copy and gave it to my manager...I will try to find it again to give exact info but I think it was in the AORN Recommended Practices and Standards Safe Practices for Electrosurgery (2005).

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Specializes in OR, Nursing Professional Development.
I think it was in the AORN Recommended Practices and Standards Safe Practices for Electrosurgery (2005).

Is there anything in the current edition (2013)? They do update this annually, and the more current would be what I'd go by.

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Specializes in Operating room..

They update standards each year or make changes to previous standards...the recommended standards and practices for electrosurgery has not changed this portion of the recommendations. The principals of adipose tissue (as opposed to a muscle mass) creating impedance (with only fat to place a bovie pad on it is not as good as a muscle mass, and therefore you have to use two pads (close together, not on different parts of the body)) to lessen the impedance. If the muscle mass is covered by fat you don't get a good "path" for the return to flow back to the ESU. Two pads decrease the impedance...interestingly, even a small person may need two pads depending on the distribution of fat on their body, also two pads should be used in cases where you might use a high bovie setting. So glad I researched this! I may not be able to explain it the best but at least I know I have verification on this.

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Never heard of it either.

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Specializes in NICU, ER, OR.

I have never heard of that nor had the need for it either, and have worked bariatric surgery and have had many many over 600lb patients.

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