Using Multiple Electrosurgical Units on One Patient: What to Do When You Can't Avoid It

ECRI periodically receives inquiries regarding whether it is acceptable for surgical teams to activate multiple electrosurgical units (ESUs) simultaneously for monopolar electrosurgery on a patient. We believe that simultaneously activating multiple ESUs, which results in multiple monopolar electrosurgical circuits within the patient, may lead to an increased risk of a patient burn as a result of one or both of the following:

1. High cumulative electrosurgical leakage current, which exits the patient's body through a path other than the intended return electrode

2. Currents that pass through the same tissue to reach their respective conductive return electrodes (i.e., current overlap or bottlenecking), causing high current density

Consequently, we recommend against routinely using...