How to Use a Diathermy Machine: Setting Power Safely

Step 1: choose the mode and the instrument

Start with the instrument and the intended tissue effect. For an incision, choose a cut mode; for control of small bleeders, coagulation; for a balance, a blend. Bipolar forceps use the bipolar socket and bipolar coagulation setting, and a monopolar pencil needs the return electrode applied before activation.

Check that every cable is in the correct socket and that the footswitch or handswitch is assigned to the right output. Wrong socket selection is a classic source of confusion when several instruments are connected, as on the ARC 400, which supports up to five.

Step 2: find the lowest effective power

The principle shared by every protocol is to begin low and increase in small steps until the desired effect is achieved with a clean, rapid pass. Excess power increases thermal spread, charring and the risk of burns and smoke, and a reading of watts is not an outcome, only a starting point.

Many hospitals publish typical starting ranges: for example, lower values for delicate tissue and bipolar work, and higher values for large muscle bundles or thick tissue with a blade or loop. These ranges differ between manufacturers and electrodes, so use them as a guide and confirm against the instructions for use of your generator. Bovie settings quoted in textbooks should never override the device manual.

Remember that the same number of watts behaves differently with a fine needle, a blade, a ball or a large loop. As electrode surface grows, the same power spreads over more tissue and the effect weakens, so settings should always be read together with the electrode in use.

Electrosurgical unit settings on BOWA generators

Modern generators reduce guesswork. The ARC series offers a WIZARD that guides the user in three steps, instrument, electrode and power, and COMFORT cables allow the unit to recognise the instrument and load suitable settings. The ARC 400 stores up to 300 favourite settings, which can be carried between units with a Dr. Dongle, so a surgeon's preferred values can be recalled quickly.

The ARC 350 comes with settings pre-programmed for numerous standard procedures, and micro-regulation down to 0.1 W for plastic surgery and neurosurgery. Maximum monopolar power is 400 W on both units, but typical working values are far below that.

Step 3: test, observe and document

Make a short test activation when the electrode is in view and in contact with tissue. Watch the effect: if tissue sticks or chars, check electrode cleanliness and lower power; if nothing happens, check pad contact and cable connections before turning power up. A sudden need for much more power is a warning sign, often of a poor return pad contact.

Record the mode and settings in the operative record. If the generator has an alarm, never silence it without finding the cause. For safety rules read electrosurgery safety guidelines, and for the difference between modes see cut, coag and blend waveforms.

If you change patient position or move the return pad, re-check the pad contact and repeat the test activation, since the settings that worked a minute earlier may no longer apply.

Common mistakes and training

Common mistakes include raising power instead of cleaning the electrode, activating without contact, using coag settings for cutting, leaving settings from the previous case, and ignoring unusual activation sounds. A short pre-list briefing prevents most of them.

Beckfinity can arrange user training when a generator is installed; contact us for a demonstration of ARC series settings with your own team.