MDT Bovie Specialist User manual

OPERATORS
MANUAL
Specialist
~lectrosur~ical Unit
MDT Diagnostic Company
- -
Technologyfor Life
500007 Rev. C

OPERATORS MANUAL 500807
Rev. 2 (12/15/81)
Rev. C ( 9/14/88) Retypedand MDT Logo and Address Added
DESCRIPTION OF SYMBOLS
& NOTES IN MANUAL
Thefollowing symbols with related notes appear in this manual.
CAUTION
"Warning" notes alert the user to the possibility of personal injury.
"Caution" notes alert the user to thepossibility of damage to the equipment.
"Notes" alert the user to pertinent facts and conditions.
Usersmust readand understand thecontents of thismanual before
using the equipment.
The
BOVlE Specialist is a sophisticated medical device intended
only for useby qualified physicians and surgeons. Misuse or mis-
application of this device may result in serious physical harm to the patient
andlor user.It is imperativethat this manual be read and understoodprior touse
of the equipment.
RETAIN THIS MANUAL FOR FUTURE REFERENCE!
-MDT, BOVlE and CHUCK-IT are registered trademarks.
i i

SECTION
TABLE OF CONTENTS
PAGE
" .
1 . INTRODUCTION
....................................................
Preface to Electrosurgery 4
.................................................
Introduction to the Specialist 1
Unpacking
............................................................ 1
........................................................
Power Requirements 4
...........................................................
Location in Office 1
2 . OPERATION
................................
Operating Controls .. ........................ 3
Description
....................................................... 4
Circuitsentry ....................................................... 4
...................
Initial Check-Out Procedure ... .............. .... ..... 5
Features .......................................................... 6
Accessories
........................................................ 6
...................
Checking Cords. Connections .... .... .. .................. 9
.....................................................
Electrosurgical Currents 9
........................ ... ...‘..........
Electrosection (CuttingCurrent) .. .. 9
Electrocoagulation
.......................................................... 9
........................... ....................
Desiccation and Fulguration .. 10
3 . SAFETY AND PRECAUTIONS
General Precautions ......................................................... 19
Anesthetic .................................................................. 11
Prevention of Burns
......................................................... 11
..............................................
Patient with Cardiac Pacemaker 12
..........................................................
Groundingthe Unit 12
................................
Preventing High-Frequency Skin Burns ... .... 12
.............................................
Review of Action Steps for Safety
13
4 . SUGGESTED POWER SETTINGS
Power Required ........................................................ 15
...................... ......... ................
Suggested Power Settings .. .. 16
...............................................
Output Power vs . Dial Settings
18
.....................................................
Electrical Specifications 19
...................................................
MechanicalSpecifications 19
....................................................
Limitations of Equipment 19
5 . EXPERIMENTS IN ELECTROSURGERY
...............................................
Preliminary Experimental Work 21
.....................................
Experiment with Electrosection (Cutting) 22
................................................
Experiments with Coagulation 23
................................ Experiments with Fulguration and Desiccation 26
Summary
................................................................... 26
..............................................
6 . ACCESSORIES & OPTIONS 27
iii

BOVlE SPECIALIST ELECTROSURGICALUNIT
AND SfANDARD ACCESSORlES
MONO-POLAR 81-POLAR HAND/ FOOT DISPERSIVE
OUTPUT
1 r FORCEPS 7 ELECTRODE
P' MANUALS-OPERATOR'S
f/ SERVICE
CHUCK HANULE
NEEDLE
POINT
\ BLADE
\ LOOP
h ~nn~
. --.
CONTROL
DISPERSIVE
ELECTRODE
HAND CONTROL
ADAPTER

BOVIE SPECIALIST ELECTROSURGICAL UNIT
1. Introduction
INTRODUCTION
PREFACE TO ELECTROSURGERY
Electrosurgery hasbecomean importantmodal-
ity in modern medicine. The BOVIE Specialist is a
versatileandsafeunitprovidingauniquecoagulation
/hemostasis waveshape with superior clinical per-
formance.Theavailabilityof accessoriesandawide
selection of electrodes will provide many surgeons
with an instrument that can beutilized effectively in
specialized minor surgery.
TheSpecialist isdesignedwithagraphic around
theCoagulatingPowerControlKnobwhich depicts
the power settings to be used for various types of
electrodes. The graphic is based on bi-terminal
techniques utilizing a dispersive electrode. It is
not
an exact setting for any procedure. However, it can
be used as an aid for safe approximate settings,
thereby reducing the chance of electrode damage
or excessive tissue destruction.
Electrosurgical unitsprovidecurrents essential
to office practice in proctology, dermatology, oral
surgery, gynecology andare also valuable inmajor
surgery.Thefinalchoiceof currentsis basedonthe
surgeon's knowledge and experience in obtaining
an incision current (Cut), a destructive current
(Coagulation/Fulguration) or a combination cur-
rent (Hemostasis).
The nature of this equipment as a low power
The Operator's Section includes a review of
"Experiments in Electrosurgery." However, the
review is
not intended as aclinical training manual,
only as a common point of reference for clinical
applications.
UNPACKING
Carefully remove the Specialist generator and
other partsfromtheshipping container. Ensurethat
no parts are discarded with the packing material.
Inspect the components for shipping damage.
Report any such damage immediately.
Usethefollowingpackinglisttoconfirm receipt
of all parts:
PACKING LIST
1. Specialist Generator Assembly
2. Active Chuck Handle
3.
Box of Five Electrodes: Ball,Point,Loop,Blade
and Needle
4. Foot Control
5. Dispersive Cable
6.
Dispersive Electrode and Tube of Liquid Gel
7. Hand Control Adapter and Sample Hand
Control
8. Operator's Manual
9. Warranty Card
electrosurgical unit makes it unadaptable to TURP
POWER REQUIREMENTS
(Transurethral Resectionof the Prostate) and some
other major surgical procedures. The Specialist is designed to operate from a
50/60 Hertz power source furnishing amaximum of
INTRODUCTION TO THE SPECIALIST
130 volts. The volt-ampere requirements are below
The BOVIESpecialist, likeall electrically oper- conventional wiring ratings.
atedequipment, must be properly installedto avoid
any chanceof electricalshock. Itis asourceof high
LOCATION INTHE OFFICE
frequency energy, and it must be used properly to
prevent excessive tissue destruction. The informa-
tion contained inthe following sections is intended
to provide a basic understanding of the factors
involved in the use and service of this equipment.
For user convenience,the manual is physically
divided into an Operator's Section and a Service
Section. These may be separated and placed in an
operatory and a service area at the user's option.
Both sections, Operator's and Service, are in-
tendedtoassisttheuser inproperBOVIEoperation.
A Parts List is included in the Service Section.
The specialist generator can be placed
on a
desk, wall or cart. The outlet must be of the three-
wire grounding type. The grounded leg must not be
cut off or by-passed with a non-grounded adapter
("Cheater plug") to avoid use of
a three-wire outlet.
If so used, the Specialist would not be properly
grounded andwill void the warranty. If there is any
doubt about the ground connection, consult your
electrical contractor and make any recommended
outlet changes.
Usethe handleon the back of the generator to
carry the Specialist.

NOTES

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
OPERATION
OPERATING CONTROLS
CUTTING POWER (yellow)
To varythe amount of
CUTTING TYPE (yellow) POwerforCutting. COAGULATINGPOWER
TO select cuttingwave AMPLITUDECONTROL (blue)
forms. Pure Cut has Makescut with hemostasis To vary the amount of
minimalHemostasis. useful indesiccation. powerfor Coagulation.
Cut with Hemostasishas
I
PULSE CONTROL
a moderate amount. Givesexcellent fulguration.
ELECTRODE SYMBOLS
(Coagulating)
Symbols are approxi-
mationsfor Bi-terminal
Procedures.
RF OUTPUT (amber)
Monitor will lightwhen
Unit
is activated. Power
is available at the
Outout Terminals.
Monitorwill light when
dispersive electrode
circuit is NOT complete.
Output power cannot be
activatedwhen
light
is ON.
POWER (white) 81-POLAR FORCEPS OUTPUT
\
DISPERSIVE ELECTRODE
ON-OFF Switch tor Awhite and a Receptacle for
main power to the tjlack receptacle for Dispersive Electrode
unit. Indicator
will Bi-polar Forceps plugs. Cable.
llghtwhen switch is
(Footactuated only).
ON. MONO-POLAROUTPUT HANDIFOOT CONTROL
White receptaclefor Receptacletor Foot
Chuck Handles or Controlor Hand
Adapter. ControlAccessories.
CONTROLS, OUTLETS AND MONITORS

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
DESCRIPTION
Electrosurgical units are alternating current
generatorsof highfrequency. Passageofthesecur-
rentsthrough livingtissuewill notcause nervestim-
ulation. The BOVlE Specialist operates at a funda-
mental frequency of
1.75 megahertz, and at ranges
that pass through tissue with nostimulating effect
except for the normal heating produced by all elec-
trosurgical currents.
Controls - Providethe operator with aselection of
two cutting modes and adjustment of output levels
for Cutting and Coagulating.
Receptacles - On the Front Panel supply output
power to electrodes and receives signals from
Footswitch pedals or hand actuated controls.
Coagulating - Will always override Cutting if an
attempt is made to energize both simultaneously.
Coagulating being the safest or least destructive
modeof operation.
Monitors - Lightson the front panel indicate nor-
mal or faulty operation of the equipment.
The
amber monitor indicates actuation of either
the Cutting or Coagulating mode.
The
red monitor indicates an incomplete disper-
sive electrodecircuitandthedisablingoftheout-
put power. This is the normal operation of the
Circuit Sentry Monitor.
Audible Signal -The specialistcontainsatwotone
audiblesignalPo indicatewhen the output power is
activatedandinwhich modethe unitisoperating.
A
higherpitchedtoneindicatestheCuttingmodeand
a lower pitched tone indicates the Coagulating
mode. Volume of the audible signal is adjusted by
turning the level control, accessible through the
bottom of the unit.
CIRCUIT SENTRY
A D.C. monitor signal flows from the specialist
through one wire of the dispersive electrode cable
to the dispersive electrode. The signal returns
through the other cable wire, and the Specialist is
ready to operate.
The red Circuit Sentry monitor
light will be off.
Ifthe circuit path is interrupted by morethan a
200 Ohm resistance,the RED monitor light will go
on, and the unit will automatically shut off.
DISPERSIVE ELECTRODE
--__F___t-
DISPERSIVE ELECTRODE RECEPTACLE
CIRCUIT SENTRY

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
INITIAL CHECK-OUT PROCEDURE
1.
Turnthethreecontrol knobstothefull counter-
7.
Actuate the footswitch in the CUT mode. The
clockwise position. Amber RF OUTPUT monitor will light and the
2.
Insert the AC Power Plug into a three-wire high pitch audible signal will sound.
grounded type
115 volt/60 Hz. service outlet.
8.
Actuate the footswitch inthe COAG mode.The
3. Without attachingany accessories, depressthe amber RF OUTPUT monitor will light and the
white powerON/OFF buttonto ON.Thebutton low pitch audible signal will sound.
will lightandthered CIRCUITSENTRY monitor
light will go ON. -rhe unit is now ready for
9. Selecttheapplicableactiveaccessor~andelec-
accessory connection. trode for the required surgical procedure.
4.
Insert the Dispersive Electrode Cable into the The surgeon should become familiar with the
DISPERSIVE ELECTRODE receptacle. use of the BOVlE Specialist before any actual
procedures are attempted. Technique experiments
5. Attach the blue plastic cable connector to the are reviewed in the Experiments Set-
Dispersive Electrode.Useastraight pull on the
tion.. of this manual will prove helpful to
grip surface of the connector. skilled surgeon to develop an operational feel for
This connection will complete the circuit and the unique>haracteristicsof thi~'~articularelectro-
thered CIRCUITSENTRY monitorwill goOFF. surgical equipment.
The BOVlESpecialist is now ready to actuate. Inaddition, the surgeon should become fam~l-
6. Connectthefootswitchadapter intothe HAND/ iar with the "General Safety and Precaut~ons"sec-
FOOTCONTROL receptacle. Rotate pluguntil tionof this manual.Thesebriefstatementswill br~ng
the keyways mesh, then turn knurled portion tomindmanyof theconcerns andpotentialhazards
clockwise to secure pl inherent to electrosurgery.
ACTIVE CHUCK
HANDLE AND CORD
DISPERSIVE
ELECTRODE CABLE
ACTIVE ELECTRODE
DISPERSIVE ELECTRODE
GENERATOR AND ACCESSORIES

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
FEATURES ACCESSORIES
Thesafety andversatilityof the BOVlESpecial-
Active Electrode Outputs
ist include the following features:
e CircuitSentry monitoring (DispersiveElectrode). Allactiveaccessories leadsshouldbe
10
e Coagulation overrise when inadvertentactuation foot
in length to obtain maximumoperat-
of Cut and Coagulate is simultaneous. ingefficiency.
e Coagulation ElectrodeSymbols.
a Outputonly to the selected active electrode. Active electrodes can beenergized by either a
e Distinctive separate audio tones. foot control or a hand control. This is shown inthe
Bipolar outlet. following illustration.
TYPE OF
ACTUATION ACCESSORY CHUCK HANDLE WITH
/- SINGLE ELECTRODE
,P- MONOPOLAR
CONTROL MONOPOLAR FORCEPS
BIPOLAR BIPOLAR FORCEPS
HAND
CONTROL MONOPOLAR CHUCK HANDLE WITH
SINGLE ELECTRODE
ACTIVE ELECTRODES
Reusable Chuck Handle
This type of active accessory is the mostversa- pletely until the chuck jaws insidethe chuck handle
tile of all shapes and configurations for surgeon are fully opened. To open, hold the barrel of the
preference.Thecordplugsdirectly intothe MONO- chuck handle while turning the cable end counter-
POLAR OUTPUT receptacle. clockwise. Seat the electrode fully and close chuck
jaws by turning the end of the chuck handle clock-
Insert the electrode into the open end of the
wise.
chuck handle. The electrode may not seat com-
C) INSERT AND SEAT CLOSE
ELECTRODE HANDLE
INSERTING ELECTRODE INTO HANDLE

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
Optional DisposableChuck Handle(Chuck-it)@
A disposable chuck handle is used with the
1. Plugthe insert terminal into the adapter.. Itwill
addition of a BOVlE adapter. The electrodes slip besecured by a spring latch.
directly into the chuck handle; there is no locking
twist. .Some chuck handles are supplied with the
2.
Plugthe adapter intothe white MONO-POLAR
electrode built intothe chuck handle. OUTPUT receptacle.
DISPOSABLE CHUCK HANDLE ELECTRODE
I
1
TO WHITE MONOPOLAR
OUTPUT RECEPTACLE
___)
ADAPTER
DISPOSABLE CHUCK HANDLE
Optional Hand Control
TheBOVIESpecialistcanaccommodateahand Thehandadapter plugs intothe same recepta-
controlwiththe useof aplugadapter. Handcontrols cleas thefoot control.When the handcontroladap-
providefingertip control of the cutting or coagulat- ter is connected, the foot control output circuits are
ingcurrents. They are used inplace of the conven- disconnected.
tional footswitch control.
HAND CONTROL
TO SPECIALIST
3-PIN CONNECTOR HAND/FOOT CONTROL RECEPTACLE
-
HAND CONTROL ADAPTER
HAND CONTROL .

BOVIE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
FootswitchControl
latingcurrentswith this adapter requirebi-terminal
techniques sincebothbladis of thi monopolar for-
Power output from the white monopolar recep- cepsareactive. Coagulatingcurrentsmustreturnto
tacle can beobtained only with afootswitchacces-
the dispersive electrode, for effective tissue necro-
sory.Thisoutletallowsany monopolaraccessory to sis.
A coagulating power setting can be estimated
produce cut or coagulation currents. by comparing electrode pictorial size on the gra-
1.
Poconnectthe footswitch plug, slowly turnthe phics
to m~n~~~larf~r~ep~bladesize beingused. A
flexible connector portion of the plug untilthe smaller area of contact would require less Power.
pins mesh with the receptacle holes.
Bipolar Forceps - Bipolar forceps techniques re-
quirecoagulationcurrentstoflowfromone bladeof
2.
Turn the knurled portion of the plug clockwise the forceps through a small area of tissue to the
to lock the plug intothe receptacle. other forceps blade. Because of this small area of
Forceps
contact, power must be radically reduced. The
coagulation graphics as presented on the BOVIE
Specialist do not represent suggested settings,
Forceps are used to grip tissue between the because technique depends on various forceps
blades or tips of the electrode. Coagulationcurrent blade sizes, tissue grip and areas of contact. Lower
shouldbeappliedaftertheforcepsgraspthetissue. settings than normal should be used until the sur-
Effectiveness of forceps coagulation depends on geon acquires a"feel" for the Specialist and its uni-
the size Of the blades and the surface area Of the
que capabilities. Surgical procedures using bipolar
tissue gripped. Larger blades require more power, coagulation can be referenced only by skill and
also, as the volume of the tissue being gripped experience similar to that obtained for cutting
increases, the power requirement increases. currents.
There are two distinct modes of forceps opera-
tion;monopolaranddipolar. Eachhavedistinct clin-
ical effects which should be observed by the sur-
geon. Monopolar forceps coagulate at the gripped
tissue first and then deeper into the tissue as the
application of current continues. Bipolar forceps
coagulate across the gripped tissue.
Monopolar Forceps - Monopolar forceps tech-
niques require footswitch activation, power being
availableatthewhitemonopolarreceptacle.Coagu-
ACTIVE
/cl
MONOPOLAR
Dependingon the accessory used, bipolar for-
ceps may beactuated by either footswitch or hand
control. The dispersive electrode is always con-
nected and need noactuation. The black outlet for
the indifferent electrode acts as a current return
path in placeof the dispersive electrode.
Both cutting and coagulation currents are
available at these outlets, and determination of
coagulating power settings are at the discretion of
the surgeon.
ACTIVE /// ,
FLOW
BIPOLAR
FORCEPS COAGULATION

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
DispersiveElectrodes
The reusable stainless steel dispersive elec-
trode must becleanto ensure a safe and good con-
tact. Always clean after each use. To clean, discon-
necttheelectrodecordfromtheelectrode andwash
inhotwater with milddetergent, rinseand dry thor-
oughly with
a towel.
Disposable dispersive electrode should be
highlyflexible,havemedicalgradeadhesive, andbe
applied with a liberal amount of electrosurgical
conductive medium (BOVIE Gel Conductor). The
dispersive electrode should be largeenough for the
fulloutput of the generator.Therecommendedmin-
imumarea for the Specialist is 50cm2
(7.8 in.2).Fol-
low all manufacturer's instructionsand recommen-
dations when using disposable dispersive elec-
trodes.
CHECKING CORDS, CONNECTIONS
It is important that all cords and plugs be fre-
quently checked for breaks in insulation or electri-
cal contact. When plugs are pulled out of recepta-
cles,
grasp the plug, not the cord. Jerking on the
cords may pull the connections loose.
Ageandrepeatedsterilizationscancause
cracks ininsulation which might result in
burns to patient or surgeon.
Disposable Chuck-It active cables and disper-
sive electrodecables are completely tested for con-
tinuity at the factory. This eliminates the need for
any test before use.
ELECTROSURGICAL CURRENTS1
The BOVlE Specialist, as indicated earlier, is
designed to provide high-frequency energy for the
purpose of cutting, coagulating, desiccation or
fulguration.
ELECTROSECTION (Cutting Current)
Pure Cut
Thewaveform of the Pure Cut current is essen-
tially sinusoidal. Its effect is to heat tissue cells so
quickly that they volatilize or explode inthe path of
the electrode. Tissue parting is similar to a sharp
cutting blade. The heat generated by the electrode
arcing also causes a slight zone of dehydration at
the severed edges.This will seal off minutevessels.
ThePureCut current is almost devoidof any dehy-
drating effect. Its usefulness therefore, is predomi-
nantly innonvascular areas or where fast cutting is
the only requirement.
It has advantages in confined areas where the
utilizationof the cold scalpel becomes impractical.
Application of the cutting current of the BOVlE
Specialist is
always bi-terminal (dispersive elec-
trode) and requires more understanding and skill
than the dehydrating currents.
Cut with Hemostasis
Clinical requirements for cutting with a dehy-
dratingeffect requiresablendof cuttingandcoagu-
latingcurrents with the result being acutting capa-
ble of sealing small vessels during electrosection.
The BOVlE Specialist provides this hemostasis by
the surgeon's selection of cutting type. This hemo-
stasis cutting current could be a more desirable
method on some electrosection since a moderate
amount of dehydration will occur.
This mode can also be used very effectively in
desiccation coagulation where a precise fine spark
is desired.
ELECTROCOAGULATION
Coagulationis always bi-terminal (dispersiveor
indifferent electrode is used) and tends to produce
more necrosis of tissue than desiccation. The des-
truction effects are not as quickly limited by azone
of dehydration. Therefore, this current is more
effective on large or deep growths. Active elec-
trodes such as needles, pointed rods,or small balls
are always used in contact with the tissue; either
firmly pressed against the tissue to be coagulated,
or inserted into it. The tissue area of contact being
constant, the amount of coagulation around the
electrode is dependent on the amount of current
and length of time it is applied.
Continued
. .
'Adapted from Principalsof Minor Electrosurgery,John F. Otto,
Jr.,
M.D., Liebel-Flarsheim Company, 1957. Pages 8-1 1

BOVlE SPECIALIST ELECTROSURGICAL UNIT
2. Operation
For effective coagulation on a large growth,
lengthof time is moreimportant than the amount of
current.TheSpecialistgraphic indicates suggested
power adjustinents or settings for the type of elec-
trode indicated. Emphasis again is 'placed on the
many procedures where variations in power set-
tings depend largely on the experience and judg-
ment of the surgeon. The processof coagulation is
dependent on areas of highest current concentra-
tionwhere dehydrationandcarbonization will occur
first. Skilled surgeons in their procedures have
found short times with high power are notas effec-
tive as low power and longer times if deeper pene-
tration is desired.
In applications of a penetrating needle elec-
trode, coagulation beginsat its point, this beingthe
areaof highestcurrentdensity. Dehydrationoccurs
and lossof conductivityat this pointforces current
to dehydrate successive areas of less penetration.
While the current is left on, the ascending area of
coagulum, broadens in a cone-like fashion until it
becomes evident at the surface. Ball or flat blade
electrodes in contact with tissue for coagulaton
purposes depend on area of contact, power setting
and time to produce the clinical requirement. The
effect isadehydration of descendingnaturetowards
the dispersive electrode.
DESICCATION AND FULGURATlON
Desiccation is usually a bi-terminal technique
with dispersive electrode. Many surgeons find the
amplitudecontrolledcutwith hemostasiswaveform
ideal for this precise form-of coagulation. You will
findthat spark intensity diminishes asthecut power
control is turned to lower settings. Phis produces
the short fine spark appropriate for dermatology
and facial surgery.
In the process of fulguration, the coagulation
currentjumps from apointedactive electrodetothe
large mass of the patient. Fulguration being a sur-
face dehydrator, becomesself-limiting, since dehy-
drated areas are non-conductive to currents. The
sameeffecthappensiftheactiveelectrode becomes
coated with coagulum.
The effectiveness of desiccation and fulgura-
tion are superficial, and therefore are preferred
when cosmetic results are important.

BOVIE SPECIALIST ELECTROSURGICAL UNIT
3. Safety & Precautions
GENERAL PRECAUTIONS
SAFETY & PRECAUTIONS
Certain general precautions are neces-
saryintheuseofanyelectrosurgicalunit.
Readandobserve them carefully.
TheBOVIESpecialistElectrosurgicalunit
issoldonlyfor usebyqualifiedphysicians
and surgeons. The observance of safe
and
establishedmedicalpractices isessen-
tial to itsproper use, otherwise, there are
possibilities of injury to patients or oper-
ators.
1.
Operator andpatientsafety areof primeimpor-
tanceinelectrosurgicalapplications. Duetothe
necessity of high voltages in any electrosurgi-
cal instrument, added precautions have been
taken in the BOVIESpecialist.
2.
Inbi-terminal techniques,properapplicationof
the dispersive platewith conductivegel usually
will require less powerfor good clinical results.
3.
Theactive cable, regardless of accessory used,
should NOTbecoiled, but let droop away from
the patient and operator and preferably away
from large metal masses.
--
The safe and effective use of elecfro-
surgery is dependent, to a large extent,
upon factors under the control of the
operator and not entirely controllable by
the design of this equipment.Itis impera-
tivethattheinstructions suppliedwiththis equipmentbe
read, understoodandfollowed in order that safety and
effectiveness be enhanced.
ANESTHETIC
Theuseof anelectrosurgical apparatus imposes
some limitations on the type of anesthetics which
can be safely used. Choiceof anesthesia should be
madewith full consideration of the danger of using
electrical sparks inthepresenceof explosivegases.
The best rule is to avoid
all flammable anesthetics;
and it should be'recognized that many commonly
used inhalant anesthetics
are flammable - espe-
cially so when used with oxygen.
With present-day techniques of administering
spinal, intramuscular, oral and rectal anesthetics,
the surgeon or anesthesiologist has a wide choice
from which to select an appropriate anesthesia for
any electrosurgical procedure.
Useoflocalanesthetic may requirean increase
inpowerifthe operatingfield containsaheavy fluid
content of injectable anesthetic. It is generally bet-
ter to inject an anesthetic a little distance from the
lesion itself, allowing it to serve more as a block
anesthesia rather than injecting directly under the
lesion.
PREVENTION OF BURNS
Accidental Ignition
of Flammable Fluids
When a flammable fluid, such as alcohol or
ether, is used to cleanse the field preparatory to
surgery, it iswell to rememberthat there is a possi-
bilityof ignitingany gasor residualliquidby aspark
from the electrode. When flammable fluids or sol-
vents are used, allow sufficient time for complete
evaporation and be sure that drapes, dressings,
coverings, clothing, etc., surrounding the field are
not saturated with the liquid.
Accidental Ignition of Flammable Gases
The risk of ignition of flammable gases or other
materials is an in
herent hazard inthe useof Electro-
surgery which cannot be entirely eliminated by
device design. Precautions must be taken by the
user to restrict flammable gases and liquids -
whether fromanestheticorskin preparationagents,
or present insurgical drapes.
Disposable anesthesia hoses are conductive
and will burn if touched by an active electrode.
Avoidance of Internal Body Gases
Another precautionwhich must beobserved is
the avoidance of any flammable gases within the
body. This is especially true in body cavities. It
should also be kept in mind that colonic gases are
flammableandshouldbedispersedwith nitrogenor
carbondioxidebeforeapplying energy inthecolon.

BOVIE SPECIALIST ELECTROSURGICAL UNIT
3. Safety (h Precautions
PATIENT WITH CARDIAC PACEMAKER
Itisveryimportanttoknowifthepatientisusing
a pacer since high-frequency energy can interfere
with its action. This is particularly true of the
demand type pacerwhich depends on theabsence
of signal for its triggering. Interaction with pacers
and other heart contact devices can be minimized
by placementof the dispersive electrode so that the
highfrequency energy path is remotefrom the area
surrounding the heart and any heart contacting
devices.
GROUNDING THE UNIT
1.
Besure that the chassis of the unit isgrounded
in accordance with grounding instructions,
otherwise,there ispossibility
- remotebut real
- of shock to patient or surgeon. Grounding
instructionsare identifiedinthe"Introduction"
section.
2.
Do not increase power output beforechecking
forobvious defects or misapplication.Apparent
low poweroutput or failure of the Electrosurgi-
cal equipment to function correctly at other-
wise normal settings may indicate faulty appli-
cation of the dispersive electrode, or failure of
an electrical lead.
3.
Electrosurgical leads should be positioned so
they cannot contact the patient or other leads
connected to the patient; nor should they run
parallel, close to other leads.
PREVENTING HIGH-FREQUENCY SKIN
BURNS
1.
Accidental burns are possible from the disper-
sive electrode (if improperly prepared or ap-
plied) or from the active electrode if it is care-
lesslyhandledor laidonthe patientwhen notin
use.
2.
The dispersive electrode must be kept clean
and smooth and should always beapplied with
agenerous application of
BOVIE Liquidor Gel
Conductor. Wet towels or soap lather should
not be used, as conductive agents, as they
might dry out, resulting in a highifrequency
skin burnto the patient. Under no circumstan-
ces should the dispersive electrode be applied
over matted hair or hard scar tissue.
3.
Follow directions and recommended practices
for the preparation, placement, surveillance,
removal and use of any dispersive electrodes.
The use and proper placement of a dispersive
electrodeisa key element inthesafeandeffec-
tive use of Electrosurgery, particularly in the
prevention of burns.
4. Becauseoftherisk ofburns,needlesshouldnot
be used as dispersive electrodes.
5.
To minimize the possibility of localized burns
resulting from stray electrosurgical currents,
the patient should not beallowed to come into
contact with grounded metal parts or other
large conductive surfaces.
6.
Physiologicalmonitoringelectrodes should be
placed as far as possible from the electrosurgi-
cal site and the dispersive electrode. This will
reduce the risk of burns at the monitoringsite.
Protective impedance incorporated into the
monitoring leads may further reduce the risks
of such burns. Needles should not be used as
monitoringelectrodes duringsuch procedures.
The use of Safety Glasses or other eye
protection isrecommendedtoprotectthe
surgeon from sparks when the Specialist
is used in conjunction with Endoscopic
instruments.
ELECTROSURGERY
IS NOTANAPPROPRIATE MO-
DALITY FOR CIRCUMCISIONPROCEDURES.

BOVlE SPECIRLIST ELECTROSURGICAL UNIT
3. Safety & Precautions
REVIEW OF ACTION STEPS FOR SAFETY
These steps should be observed for the
safetyofthepatientandoperatingperson-
nel.
1. Explosion Hazards
a. Avoid flammable anesthetic.
b. Avoid flammable prep solutions.
c. Remove gas from colon prior to internal
surgery.
2. Shock Hazard
a. Groundequipment, not the patient.
b. If electrosurgery is essential on a patient
with a pacemaker, keep RF out of area of
pacer.Bepreparedtoshuntademandpacer
with magnet and closely monitor patient
activity.
3. Patient Burn
a. Use adequate area dispersive electrode for
bi-terminal procedures.
b. Avoid patient contact with extraneous
ground points when using mono-terminal
techniques.
c. Avoid hair and scar tissue under dispersive
electrode.
d. Do not place dispersive electrode at bony
protrusion.
e. Makeskin contact uniform by using BOVlE
Liquid or BOVlEGel Conductor.
f. Keep reusable plates clean.
g. Keep dispersive electrode as close to sur-
gerysiteas practicalbutonoppositesideof
trunk orlimbratherthanadjacent so current
flows through body, not on skin.
R. Do not activate Electrosurgical unit unless
active electrode is in contact with tissue to
becut or coagulated.
i.
Donot passelectrosurgical currents through
patient tissue containing metal implants.
Localized heating may occur.
4. Surgeon Burn
a. Wear eye protection when using RF on
scope type instruments.
b. Avoid metal eyeglass frames.
c. Avoid metal eye pieces on scopes.
d. Useheavy duty rubber gloves.
e. Donot activate ESU unless active electrode
is incontact with tissue to be operated on.
TheBOVlESpecialistmethodof activating only
oneaccessory functionat atimeeliminatesthe pos-
sibility of inadvertently laying down an active elec-
trode that may become energized when another
accessory is used.
A hemostat,used inconjunctionwith coagulat-
ing currents, should be insulated at the point of
operator contact.

NOTES

BOVlE SPECIALIST ELECTROSURGICAL UNIT
4. Common Power Settings
COMMON POWER SETTINGS
POWER REQUIRED
TheCutting and Coagulating controls must be
set at the required power. The amount of power
required, either for cuttingor coagulating, involves
a number of variables. To determine the best set-
tings, experience plusfamiliarity with the Specialist
anditselectrodesis required. For ageneral ruleand
guide, see the Power Setting Chart inthis section.
With the fundamental principles understood, little
difficulty should beexperienced in makingthe cor-
rectsettingsfor different types of work. Thedegree
of hemostasis required with the cutting current is
selected by setting the Cutting Type selector.
Cutting Power Required Varies According to:
1,
Natureof tissuetobesectioned. Fator cartilage
requires morepowerthan skin or muscle. Scle-
rotic, fibrotic or cicatrical tissues will require
more power than softer tissue.
2.
Depth of incision. A deep incision (with the
same electrode and a given speed of cut)
requires more power than a shallow one.
3.
Rate of speed at which cutting electrodes is
moved.Fastcutsrequiremore powerthanslow.
Slow cuts produce more hemostasis.
4.
Type of electrode used. For a given depth of
incisionwith equivalent speed of cutting.Power
requiredwill dependonthesizeof the electrode
used. The thinner the electrode, the less power
required.
Coagulation Power Required Varies According to:
1.
Length of time current is applied. Contrary to
what might be expected, a lower power for a
longer time will give greater depth of coagula-
tion than will a highpower setting for ashorter
time.
2. Type of electrode used. A heavy electrode, ball
or disc,will requirea higher power setting than
pointed electrodes, due to the larger area of
tissue contact.
3. Character of surrounding media. More power
will berequiredfor coagulation under water or
in a bloody field than for csagulation in a rea-
sonably dry field.
Coagulating Graphic
This graphic provides the skilled surgeon the
opportunity to recognize the approximate power
settings for the type of electrode used.
If the lowest possible power setting is used,
which will allowfreecuttingat adesireddepth,there
will be a minimum of sparking and flashing at the
electrode. This prolongs the life of the operating
instruments and prevents charring and excessive
coagulation of the wound edges.
COAGULATING
COAGULATING POWER GRAPHIC

BOVlE SPECIALIST' ELECTROSURGICAL UNlT
4. Common Power Settings
With these fundamentals in mind, it can be seen that power settings are not fixed,
unalterable figures, but are subject to individual variation. Therefore, it should be
recognized that best resultsare attained when the power settings are alteredto meet
the immediateor existing conditions.
COMMON POWER SETTINGS
f TYPE POWER \
PURE CUT WlTH
Cur l€haxTrns
1
\
'0 10'
J
CUTTlffi COAGULATING
ELECTROSURGICAL UNlT
Power settings listed
are
approximate.
Keratoses Remove lesions with sharp curet.
Treat base with fulgurating or desic-
cative current.
1 Aborting Boils
I I
3
Insert coarse needle into center of
necrotic area.
Sebaceous Cyst
Plantar Warts
Nasal Polyps
(electrocutting)
Skin Tumors
Place loop over polyp at ~tspedicle.
Apply power and cut through uslng
light pressure. If necessary, lightly
coagulate base.
PURE CUT
CUT/HEMO
4-5
NOSE AND THROAT SURGERY
3
3
3
I Use loop electrode.
Tonsil Tags
Incisionof
Abscesses
7
Epistaxis
Insert needle into center of cyst.
Use loop.Cut intocenter of wart and
rotateloop
180" Useneedleto coag-
ulate.
4-5
3-4
Use heavy pointed rod, straight or
curved. Use ball for more superficial
destruction.
Usecoarseneedle.Slowcut produces
more coagulation of wound edges
and prevents premature closure.
Useballelectrode incontactwithsur-
face. Avoid contact with metal
soeculum.
CUT/HEMO 3