Question

When a patient with a CIED is undergoing a procedure involving monopolar electrosurgery, the dispersive electrode (""Bovie pad"") should:

A) Not be used.
B) Be placed directly over the pulse generator.
C) Be placed so the current return path is directed through the pulse generator and leads.
D) Be placed so the current return path is directed away from the pulse generator and leads.
E) Always be on the lower extremities.

Answer 1

For patients with a Cardiac Implantable Electronic Device (CIED) undergoing monopolar electrosurgery, the dispersive electrode should be positioned to direct the current away from the CIED to prevent interference and potential damage.

Step-by-step explanation:

When a patient with a Cardiac Implantable Electronic Device (CIED) is undergoing a procedure involving monopolar electrosurgery, the dispersive electrode (commonly referred to as a "Bovie pad") should be placed so the current return path is directed away from the pulse generator and leads. The correct answer to the question is option D) Be placed so the current return path is directed away from the pulse generator and leads. This practice minimizes the risk of electrical current interference with the CIED and prevents potential damage to the device or harm to the patient.

The dispersive electrode functions as a large surface area to dissipate the electrical current and minimize heating at the site of the pad. Considering the concept that current density is greater at points or edges, such as the sharp edge of a scalpel during electrosurgery, it is also preferable to avoid paths that would concentrate current at sharp edges or narrow conduits, potentially including the leads of a CIED. High-frequency AC is typically used in electrosurgical procedures because it minimizes muscle stimulation and allows cutting or coagulation with less risk of neuromuscular excitation.