Bovie grounding pads

[target98765]

Hi all,

Just curious, I was told my a rep for bovies that you should use a bovie pad based on the actual surface area the patient had available, so if you have a young child that has enough body surface for an adult bovie pad you could place and adult pad on them. I was told the large the pad the better. Has anyone else heard this or used this practice for bovie pads?

[Rose_Queen, BSN, MSN, RN]

Our pediatric pad has a weight limit posted on it. Kid over that weight gets the adult pad, of which we have only one size. The only other thing I've heard from our reps is as close to the surgical site as possible is better.

[WhoDatWhoDare, BSN, RN]

Burns can occur when the return electrode's surface area begins to get smaller and smaller, concentrating the pathway for the return energy to travel. An example could be when the return electrode starts to peel away from repositioning or poor pad adhesion to the skin. There are safety features built into the ESU to minimize this risk, so I can understand wanting to use the biggest available. However, for kids, the pedi pads are smaller because the larger adult pads might be inadvertently placed over a boney prominence or an area where there isn't much muscle, simply because it isn't sized for the patient and increasing the risk of injury.

Alternatively, you could look into the use of a large capacitive return electrode pad, such as the Megasoft from Megadyne. I'm not a rep, but we do have a couple of these pads at my hospital. Some of the benefits I can think of are that these are reusable, doesn't require placement directly against the patient's skin (you can place a draw sheet between it and the patient) and these cannot cause burns (because the returned energy is over an extremely large area, versus a comparatively small stick on pad surface area).

[RobtheORNurse]

The important thing to remember is that it has to do with impedance, the larger the surface area, the lower the impedence and therefore the lower heat generated. If using a pediatric pad, which is recommended and pads have weight ranges on them, do not use high power electrosurgery settings. The pad will have the ranges on them. Go by the written directions on the product as these have been cleared by the FDA

[RN cypress]

I know we're not supposed to put a grounding pad near implants, but has anyone ever seen a burn due to a pad near one?

[Junebug59, RN]

We use the Megadyne Gel Pad, so no bovie pads for us any longer.... TTL

[Cinthia L]

Wrong chat

[Junebug59, RN]

Hi and congrats!

Many hospitals have the Star Programs for New Nursing Grads.  They will train you to work in the dept you've been hired for.  I believe most have you sign a contract also.  Call your nearby hospitals and inquire.  

*this thread is for the topic on bovies.  start a new thread and you'll have more responses.*

[Junebug59, RN]

Over the course of 4 decades of working in the o.r., I have never seen a burn from a bovie pad.   I've always been taught that it isn't the metal in the area that can cause problems, but the scar tissue caused by the implantation of said metal.  Scar tissue is not conductive due to less "water" in the tissues....

[affurman, BSN, RN]

On 3/23/2021 at 5:02 PM, RN cypress said:

I know we're not supposed to put a grounding pad near implants, but has anyone ever seen a burn due to a pad near one?

Yes. Someone at another facility had put the pad on the back of a knee that had been replaced. It was a horrible mess. Burn was the size of the pad and required several more surgeries to fix. I was in on two of the four or five the patient had. It was ugly. 

[11Blader]

Four decades in the OR and the only pad burn I've personally seen was from a metal ground plate used on a patient who had surgery in Mexico. The bovie machine was some relic from the 1950s and they didn't have good contact with the skin, hence the burn. Plastics service was skin grafting the burned area.