What’s New in AORN’s Guideline for the Safe Use of Surgical Energy Devices – 2026 Update

Making Surgery Safer for the Expanding Role of Surgical Energy in Today's OR

Surgical energy devices continue to help shape modern perioperative practice, touching nearly every specialty. At the same time, the use of surgical energy devices introduces new safety considerations as these devices and others evolve. AORN's newly updated Guideline for the Safe Use of Surgical Energy Devices (2026) reflects that reality with clearer direction, new recommendations, and expanded sections designed for today's OR.

Renae Wright, DNP, RN, EBP-C, CNOR, is a Senior Perioperative Practice Specialist at AORN and the lead author for the updated guideline. Wright shares an early look at the changes periop nurses need to know about:

"The first big change is the guideline title – it's been revised to the Safe Use of Surgical Energy Devices to better reflect that broader scope of technologies used in surgery. It's not just about monopolar pencils and bipolar forceps anymore."

The updated edition includes 67 recommendations—12 new, 51 revised, and 4 that are unchanged—plus two new sections on return electrodes and quality to make content easier to find and apply.

What's New: Safe Use of Surgical Energy Devices – Guideline at a Glance

Major Practice Changes:

• Interdisciplinary evaluation of surgical energy device selection
• Clear preference for dual-foil conductive and capacitive return electrodes
• Updated guidance for return electrode placement
• A significantly expanded, standardized approach to managing implanted electronic devices (IEDs)
• A new Quality section for tracking events and improving processes
• Reinforced alignment with AORN fire safety practices

Smarter Device & Pad Choices: From Evaluation to Application

A New Team-Based Approach to Device Selection

Evidence for energy devices varies widely, and Wright emphasizes the importance of structured reviews. She says the guideline recommends that, before facilities make any decisions about adding new surgical energy devices, it's essential that an interdisciplinary team:

• Systematically review clinical outcome data.
• Compare the effectiveness and safety of different energy devices.
• Determine the benefits and harms for your specific patient population.
• Consider compatibility with devices your organization already has in use.
• Consider the specific factors specific to your facility and the procedures performed.

Updated Return Electrode Terminology & Safety Preferences

The updated guideline eliminates outdated terms like "grounding pad" or "neutral electrode." Wright explains the preferred terminology and why it matters:

"The current preferred term now is "return electrode," because it's accurate, it's really clear, and it best reflects the pad's true function, safely and effectively completing that circuit by returning electrical current back to the electrosurgical generator."

Also of note: the guideline recommends dual-foil conductive return electrodes or capacitive electrodes whenever available, with single-foil pads used only when no alternatives exist.

Pad Placement Near Tattoos, Jewelry & Orthopedic Implants

Evidence shows that modern ESUs reduce earlier concerns. Wright notes:

"We found no definitive evidence of alternate site burns associated with jewelry, metal orthopedic implants, or tattoos during standard electrosurgery using modern ESUs, and those are two important factors there."

If jewelry cannot be removed, the team should assess risk and consider alternatives. Wright says the updated guideline recommends notifying the periop team, evaluating the risks and benefits of keeping jewelry in place, and considering alternative energy sources or a battery-powered electrocautery pencil.

When Using Multiple ESUs is Unavoidable

Wright explains that the new guidance is to avoid simultaneous use when possible. She also notes that AORN understands that's not always possible, for example, during traumas when multiple surgeons are working at the same time. In those cases, Wright says the guideline recommends you:

• Follow the manufacturer's instructions for use.
• Verify the compatibility of the ESUs and accessories before use, and label accessories to correspond with each generator.
• When using a single-use conductive return electrode, use one per generator and place it as close as possible to its respective surgical site, without overlapping.
• Consider using a capacitive return electrode with two cords—one for each generator—and verify that all cord connections are secure.
• Follow standard recommendations for the return electrode you're using, whether single-use conductive or reusable capacitive.

Managing Patients with Implanted Electronic Devices

New Standardized Method for Managing IEDs

A significantly expanded section guides teams through preoperative, intraoperative, and postoperative steps. Wright highlights the critical first step:

"Preoperative consultation with the team managing the patient's IED is essential before any procedure that involves electrosurgery or other surgical energy devices that could affect the device's function."

Fire Safety & Quality: Closing the Loop

Integrating Fire Safety into Energy Use

Energy devices remain ignition sources and their use must be aligned with AORN fire safety recommendations.

The New Quality Expectations

Wright says the updated guideline adds a new focus on incident tracking: "The new recommendations support the development of a quality management plan to monitor and address adverse events and near misses associated with the use of energy devices."

Wright underscores the fire safety connection:

"We made these changes to avoid conflicting guidance and to help periop teams assess recommendations using the fire triangle, since a fire can occur only when fuel, an ignition source, and an oxidizer are present."

A Safer Path Forward

What This Means for Perioperative Practice

From improved device evaluation to clearer IED management, the updated guideline strengthens everyday safety practices—helping perioperative teams protect patients as surgical energy becomes even more central to modern care.

One more smart move? Active electrode monitoring during laparoscopic procedures—it's your early warning system for insulation failure and stray energy.

Before you toss that battery-operated electrocautery pencil, do a quick safety check: remove the wire loop or batteries to prevent any ignition risk.

The quality section isn't just lip service—it spells out how to report, investigate, and take corrective action when adverse events or near misses happen.

For cardiac IEDs, anticipate: reprogramming to asynchronous mode, having a magnet ready, and making sure an external defibrillator is close at hand.

AORN Members:

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