Argon coagulator ( argon beam coagulator, ABC ) is a new generation of electrosurgical equipment commonly used in recent years at home and abroad in the clinic, first used in the 1980s for open surgical hemostasis, the 90s began to be used in gastrointestinal endoscopy, argon coagulator treatment is also known as argon ion beam coagulation ( argon plasma coagula-tion, APC ) is a new type of controlled non-contact endoscopic coagulation. Argon plasma coagula-tion (APC) is a new type of controllable non-contact endoscopic electrocoagulation technology, with the advantages of effective hemostasis, small damage, no smoke, automatic guidance, safety and simplicity.
I. Application range
1. Applicable to all kinds of open surgery and endoscopic biopsy, hemostasis
and other treatments using high-frequency electric knife.
2. It can coagulate blood vessels with a diameter of less than 2mm, and has the best efficacy in superficial and diffuse hemorrhage (e.g., liver
wounds).
3. It also has good hemostatic effect on high impedance tissues, such as bone and ligament.
II. Working principle
Argon is a kind of inert gas that will not burn, explode, stable performance, non-toxic, tasteless, harmless to the human body.
Under the action of high-frequency and high-pressure, it is ionized into argon ions and has excellent electrical conductivity, which can continuously transfer the current to form a column of argon gas between the electrodes and the bleeding wound, and direct the energy to the surface of the target tissues to produce a highly effective and special cutting and coagulation effect.
III. Basic structure
1. Argon electric knife host argon source, argon flow meter, argon transmission device, high-frequency high-voltage
generator, argon knife foot control pedal.
2. argon knife accessories argon knife handle, negative pole plate and connecting line.
IV. Operation Procedure
1. Check whether the host of the argon electric knife and its accessories are complete and intact before use. Open the argon
argon cylinder switch, check the argon pressure, argon cylinder pressure should be maintained between 300PSI * and 2300PSI, if the pressure is less than 300PSI, should be replaced immediately.
2. Properly fix the negative plate on the patient's muscular parts, such as the outer thigh or buttocks.
3. Connect the power supply, turn on the switch of the main body of the argon electric knife, wait for the system self-test to complete, connect the argon electric
knife handle, place the foot control pedal.
4. According to the surgical site, select the mode of use: manual mode (according to the surgical need to adjust the flow of argon
) or automatic mode (automatic mode flow can be changed with the change of coagulation power).
5. Set the output power and argon flow rate according to the instructions of the machine. US FDA regulations:
The safe use range of argon flow is 4 to 12L/min.
6. The cutter head should be kept at an angle of 30 to 60 degrees with the tissue, moving slowly and evenly, and should not be perpendicular to
the tissue for operation. Each eruption lasts 1~3 seconds, the optimal working distance between the nozzle and the tissue should be maintained at about 1~2cm, when >2cm, only the blowing effect is produced and the excitation function is lost.
7. APC coagulation depth is self-limiting, generally not more than 3 mm, so it is not easy to occur tissue perforation
.
8. When finished using, close the main switch of the argon cylinder, exhaust the residual gas in the airway, and then close the flow switch
9. Adjust the output power to "0", close the switch of the main body of the argon generator, dismantle the argon generator handle and negative plate, and cut off the power supply of the main body and the foot control pedal. and foot control pedal.
V. Precautions
1. The safe use of conventional electrosurgical equipment is the same as high-frequency electrosurgery.
2. Argon gas flow during intracavity operation can cause the air pressure in the cavity to rise, should be closely monitored and adjusted in due time,
in order to prevent high air pressure caused by respiration, circulation and other dysfunctions.
3. The pressure of the argon cylinder should be checked at any time during the operation and the flow of argon gas should be reasonably adjusted. If the flow rate is too
small, the blood will not be blown out of the trauma area, which will affect the hemostatic effect; if the flow rate is too large, it is easy to blow up the burnt scabs, which will affect the coagulation effect, and there is a possibility of generating vascular air embolism.
4. The instrument nurse should clean up the adhesions in the cutter head and lumen in a timely manner so as not to block the coagulation
function. Do not place the argon cutter head on the patient when it is suspended to prevent damage to the patient's normal tissues due to high temperature or other reasons.
5. When cleaning the argon cutter head, avoid water infiltration into the inside of the handle pipe and damage the line. Argon
The handle of the argon knife is sterilized by low temperature, and the handle gas delivery hose should be loosely coiled, and folding is strictly prohibited.
6. argon knife is a precision instrument, should set up a special operating room, placed should be: positioning,
neat, standardized. Prohibit the placement of other items on the host, and pay attention to moisture, dust.
7. A person is responsible for the management and maintenance, and skillfully master its operating procedures and precautions.
Equipped with
The use of the registration book, each time the use is completed, the registration of its performance, the number of hours and signatures randomly saved.
※Non-statutory units, PSI means pounds / inches? Endoscopic argon coagulation [M]. Shanghai: Shanghai Science and Technology Education Publishing House Publishing, 2006: 12-13.