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During monopolar electrocautery, current passes from the electrosurgical unit to an active electrode (handheld pen), through the patient to a Disposable Patient Grounding Plate (dispersive electrode or return electrode monitor), and back to the electrosurgical unit to complete the circuit.

Safe use of electrocautery depends on proper grounding pad placement. The grounding pad should be placed close to the operative site on the ipsilateral side of the surgical field. Whenever feasible, the grounding pad should be positioned on well-vascularized areas of the body, preferably with substantial muscle mass, to dissipate heat more readily.

Bony prominences and areas of significant adipose tissue should be avoided because they are poor electrical conductors. Areas of excessive hair, scars, and other poorly perfused sites also do not dissipate heat well and may contribute to thermal burns.

Care should be taken to ensure that the grounding pad firmly adheres to the patient’s skin without any folds or gaps, which could trap alcohol-based antiseptic preparations. The combination of evaporating alcohol, supplemental oxygen, and electrocautery sparks in the surgical field is a significant fire risk. Adhesive barriers applied over the grounding pad before application of the surgical scrub solution are recommended to decrease this risk.

Reference Linkages:

• Olympus Academy – Basic Principles and Practices for Electrosurgery
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