SELF/Perioperative Nursing/Electro-Surgical Units/Psychomotor Skills Practice Instructions
Electro-Surgical Units – Perioperative Nursing (ECSACONM)
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for the safe setup and use of the electrosurgical unit (ESU), developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for preparing, operating, and safely managing the ESU.
During practice, non-sterile equipment and supplies may be used. For this simulation, treat every instrument, cable, electrode, and surface as though it were sterile where applicable, and treat the ESU as though it were connected to a live patient. Maintain sterile technique and electrical safety awareness throughout the exercise, and respond to any simulated fault, alarm, or contamination as you would during an actual surgical procedure.
NB: The below skills should be practiced with an assistant, and where possible in a simulated operating room environment with participants acting as the surgeon and circulating nurse.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for setting up, operating, and safely managing an electrosurgical unit, ensuring patient safety, correct equipment function, fire prevention, and appropriate response to equipment problems.
Psychomotor Skills Practice Instructions
[edit | edit source]| Step | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance | |
|---|---|---|---|---|---|
| 1 | Gather supplies (articulated) | Say aloud: "I have confirmed that the electrosurgical generator, active electrode (handpiece), patient return electrode, connecting cables, footswitch, and safety holster are available, complete, and appropriate for the planned procedure." | |||
| 2 | Inspect the ESU and components before use | Inspect the generator, active electrode, patient return electrode, cables, and connectors. Confirm that insulation is intact, connectors are undamaged, and all components are clean and functional. Remove any damaged item from service. | The generator and all accessories are inspected systematically; damaged insulation, exposed conductors, or faulty connectors are identified; any defective component is removed from service and replaced before use. | Using equipment with damaged insulation or exposed conductors; covering damage with tape; assuming an item is safe because it appears to function; failing to remove a defective component from service. | Damaged insulation is a patient safety hazard regardless of how the equipment performs. When in doubt, remove the item from service and replace it. |
| 3 | Perform pre-use functional check of the generator | Power on the generator, confirm it initializes correctly, verify that displays and alarms function, and confirm the selected settings before patient use. | The generator initializes correctly; displays, tones, and alarms function; baseline settings are confirmed and documented; the activation control (footswitch or hand control) is verified. | Proceeding without confirming generator function; ignoring an abnormal display or absent alarm; failing to verify the activation control before use. | Treat the functional check as a required safety gate. A normal display alone does not confirm the entire system is working. |
| 4 | Assess the patient return electrode site | Assess the intended return electrode site for a clean, dry, well-perfused muscle mass with intact skin, free of scar tissue, bony prominences, hair, and moisture. Select an alternative site if the intended one is unsuitable. | A clean, dry, well-perfused muscular site with intact skin is selected; scar tissue, bony prominences, hair, moisture, and implanted devices are avoided; an alternative site is chosen when necessary. | Placing the return electrode over a bony prominence, scar tissue, hair, moist skin, or an implanted device; proceeding when no safe site can be established. | The return electrode disperses current safely only with full, even skin contact. If no safe site exists, stop and consider bipolar electrosurgery or another method with the team. |
| 5 | Apply the patient return electrode | Apply the return electrode with complete, even skin contact, avoiding wrinkles, folds, gaps, or lifting edges. Position it as close to the operative site as safely possible without placing it over an implanted device. | The return electrode is applied with full, even contact and no wrinkles or lifting edges; positioned appropriately relative to the operative site; connected securely to the generator. | Wrinkles, folds, gaps, or lifting edges that reduce contact area and increase current density; poor adhesion; positioning over an implanted device. | Reduced contact area concentrates current and increases burn risk. Smooth the pad fully and confirm secure adhesion before connecting. |
| 6 | Connect cables and organize the field | Connect the active electrode, return electrode, and footswitch to the correct generator ports. Route cables safely along the edge of the sterile field to prevent tension, tangling, or tripping hazards, and place the active electrode in its safety holster. | Cables are connected to the correct ports; routed safely without tension or tangling; the active electrode is secured in its holster; the field is organized to support safe workflow. | Connecting cables to incorrect ports; leaving cables under tension or coiled tightly; leaving the active electrode on the drape instead of the holster; creating a cluttered or hazardous field. | A tidy, deliberate cable layout reduces both electrical and physical hazards. The active electrode belongs in its holster whenever it is not in use. |
| 7 | Confirm fire safety before activation | Confirm that alcohol-based skin preparation has dried completely, that no pooling remains, and that oxygen enrichment beneath the drapes has been addressed. Communicate fire risk with the surgical team before activation. | Alcohol-based preparation is confirmed dry with no pooling; oxygen-enriched conditions are addressed; fire precautions are communicated and confirmed with the team before the generator is activated. | Activating over wet alcohol-based preparation; ignoring pooled solution; activating in an oxygen-enriched atmosphere; failing to communicate fire risk with the team. | Wet alcohol prep, oxygen, and an ignition source complete the fire triangle. Activation must never proceed until all three risks have been managed. |
| 8 | Set and confirm generator settings | Select the lowest effective power setting appropriate for the procedure. Confirm each setting verbally and visually with the surgical team, and adjust in small increments of no more than 5 watts when changes are required. | The lowest effective setting is selected; settings are confirmed verbally and visually; adjustments are made in small increments and communicated clearly to the team. | Beginning at an excessively high setting; adjusting power in large increments; changing settings without confirming them visually or communicating with the team. | Small, confirmed adjustments protect tissue and keep the team aware. Always aim for the lowest setting that achieves the intended effect. |
| 9 | Activate the active electrode safely | Activate the electrode only when its tip is in contact with the intended target tissue. Never activate in air, over drapes, or over combustible materials, and return the electrode to its holster between activations. | The electrode is activated only in contact with target tissue; never activated in air or over combustible materials; returned to its safety holster between activations. | Activating the electrode in air or over the drape; resting an activated electrode on the drape; leaving the electrode out of its holster between activations. | Treat the active electrode as live at all times. Contact first, then activate; holster it the moment it is not in use. |
| 10 | Monitor for unexpected tissue effects or alarms | Continuously monitor tissue response, generator tones, and alarms during use. If an unexpected tissue effect, repeated alarm, or abnormal function occurs, stop activation and assess the equipment and circuit before continuing. | Tissue effects, tones, and alarms are monitored continuously; unexpected effects or alarms prompt an immediate stop; the generator, return electrode, cables, and circuit are assessed systematically before resuming. | Increasing power to overcome an unexpected effect; ignoring repeated alarms; continuing activation despite abnormal function; assuming a single cause without systematic assessment. | Alarms and unexpected effects are safety signals. Stop, assess the whole system, and correct the cause before resuming rather than increasing power. |
| 11 | Respond to poor return electrode contact | If a return-electrode contact alarm occurs, stop electrosurgical activation and inspect the return electrode, its adhesion, and its connections before continuing. | Activation is stopped immediately; the return electrode and its connections are inspected and corrected; electrosurgery resumes only after the cause is resolved. | Increasing power until the alarm stops; continuing to use the ESU despite the alarm; replacing the active electrode before checking the return electrode. | A contact alarm indicates a burn risk. Always investigate the return electrode first before any other troubleshooting. |
| 12 | Troubleshoot an ESU malfunction systematically | When a malfunction occurs, follow a structured troubleshooting sequence: confirm the activation control, inspect generator ports and cable connections, verify return electrode adhesion, inspect cables, replace suspect accessories, and cycle generator power only if necessary. | A structured troubleshooting sequence is followed; faults are identified efficiently; unnecessary equipment replacement is avoided; patient safety is maintained throughout. | Cycling power or replacing the generator first; assuming the return electrode is always at fault; increasing output before identifying the problem; replacing components without a systematic assessment. | Work through the system in order, from most common and least disruptive causes to least common. Structured troubleshooting is faster and safer than guessing. |
| 13 | Safely shut down the ESU after use | After the procedure, return the generator to its lowest setting or standby mode before powering it down. Disconnect cables by gripping the connectors, and remove the return electrode gently while inspecting the skin. | The generator is returned to standby or its lowest setting before shutdown; cables are disconnected by the connector; the return electrode is removed gently and the skin inspected. | Disconnecting accessories before returning the generator to a safe state; pulling cables by the cord; removing the return electrode roughly without inspecting the skin. | A calm, ordered shutdown prevents unintended activation and equipment damage. Always grip the connector, never the cable. |
| 14 | Manage equipment and complete documentation | Perform point-of-use cleaning of reusable components, remove any damaged equipment from service, and document baseline checks, generator settings, alarms, troubleshooting actions, and relevant findings according to institutional policy. | Reusable equipment receives point-of-use cleaning; damaged items are removed from service and reported; baseline checks, setting changes, alarms, and corrective actions are documented accurately. | Storing reusable items without cleaning; immersing the generator; returning damaged equipment to service; documenting only final settings or omitting alarms and corrective actions. | Thorough documentation supports traceability and quality improvement. Where biomedical support is limited, careful inspection, cleaning, and reporting become the primary means of maintaining safety. |
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | "SELF/Perioperative Nursing/Electro-Surgical Units/Psychomotor Skills Practice Instructions". Appropedia. 2026. Retrieved July 15, 2026. |