Insulation Failure -- The Unseen Risk in the OR 

 

What is insulation failure?

Electrosurgical instruments are standard in hundreds of different procedures. These instruments are designed with insulated shafts, to ensure the electric current only reaches the working end.

However, over time with normal use, insulated instruments can develop small holes and cracks in their insulation. Through these cracks electric current leakage can occur, which can cause serious, unintended complications.

Risk of Electric Current Leakage

Stray electric currents can cause unseen damage to tissue, and depending where the surgery is taking place, this damage can be harmful to the patient. Internal bleeding, lesions, and infection are all potential consequences of small electric burns caused by insulation failure.

In a study at four major urban hospitals, approximately 71% of all laparoscopic reusable sets were found to have one or more instruments with insulation failure after testing.1

The other form of complication relates to the electrothermal burn. Most electrothermal injuries to the bowel (approximately 75%) are unrecognized at the time of occurrence. The result of an unrecognized bowel injury is usually serious, often leading to long-term complications.2

What causes insulation failure and how can it be prevented? Perioperative Standards and Recommended Practices

Insulation failure can occur during normal reprocessing and routine use in the OR as insulation comes into contact with sharp instruments.

Visual inspection can often identify obvious breaks in insulation, but visual tests are often not sufficient in locating microscopic pinholes and cracks.

AORN guidelines state that insulation failure can often be prevented by checking electrosurgical instruments with an insulation tester after reprocessing and rechecking before use in the OR.


1 Montero, P, Robinson, T., Weaver, J, & Stiegmann, G. (2009) Insulation failure in laparoscopic instruments, Surgical Endoscopy, 24, 462-465
2 Wu M, et al. 2000. Complications and Recommended Practices for Electrosurgery in Laparoscopy. THE AMERICAN JOURNAL OF SURGERY. 179: 69
3 Photo supplied by McGan Technology. Caption: "Magnified insulation failure and electric current leakage discovered by wire tester on instrument shaft."

 
 

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