Electrosurgical Safety

Publication Date: July 29, 2020

Guideline for Electrosurgical Safety Recommendations

Injury Prevention

1.1 Assess the patient preoperatively for the presence of foreign bodies (eg, [implanted electronic device], jewelry, prosthetic implants).
1.2 Place patient monitoring electrodes (eg, electrocardiogram, oximetry, fetal) as far as possible from the surgical site.
1.4 During the use of monopolar devices, prevent contact between the patient and metal objects.
1.5 Remove all metal jewelry that will be between the active and passive electrodes.
1.6 Follow the manufacturer’s written instructions for use (IFU) for all ESU components.
1.7 Perform the following fire prevention interventions when using an electrosurgical device:
• use technologies other than monopolar (eg, bipolar devices, coblation technology, non-energy-applying instruments) during surgical procedures on anatomical structures that present special fire hazards (eg, bowel, trachea);
• use moist radiopaque sponges near the ignition source;
• remove alcohol-soaked sponges or other application devices from the sterile field; and
• allow alcohol-based solutions to dry and fumes to dissipate before using any type of electrosurgical active electrodes.
1.9 When patient or personnel injuries or equipment failures occur during the use of an electrosurgical generator or accessories,
• remove the electrosurgical generator and accessories from service;
• retain all accessories and packaging if possible; and
• report the adverse event details, including device identification and maintenance and service information, according to the health care organization’s policy and procedures.

ESU Accessories

3.1 Use accessories that are compatible with the generator as specified in the manufacturers’ IFU.
3.3 Secure electrosurgical accessory cords to the sterile drapes
• with a non-piercing plastic or other nonconductive device, and
• in a manner that does not crush or damage the cord or compromise the sterile field.
3.5 Visually inspect electrosurgical accessories for damage (eg, insulation breakage) before and after use and, if reusable, during reprocessing.
3.7 The electrosurgical generator foot pedal activation switch should be activated exclusively by the person in control of the active device.
3.9 When using an active electrode,
• connect the cord directly into a designated receptacle on the electrosurgical generator;
• place the electrode in a clean, dry, nonconductive safety holster when it is not in use; and
• use only adaptors approved by the manufacturer of the ESU and the accessory.
3.10 Do not activate the active electrode until it is in close proximity to the surface if fulgurating, or in contact with the target tissue if cutting or coagulating. (Recommendation)

Recommendation Grading




Electrosurgical Safety

Authoring Organization

Publication Month/Year

July 29, 2020

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Surgical technologist, nurse, medical techologist technician, nurse practitioner, physician, physician assistant


Diagnosis, Prevention

Diseases/Conditions (MeSH)

D004598 - Electrosurgery


electrosurgical units, ESUs, electrocautery devices, argon-enhanced coagulators, dispersive electrode