Transcript Management Of Surgical Smoke

Management of
Surgical Smoke
in the
Perioperative
Setting
44-year old surgeon developed
laryngeal papillomatosis
Biopsy identified the same virus type as
anogenital condyloma
Hallmo, et al (1991)
394
400
350
311
300
250
200
137
109
150
100
50
0
Yes
No
N/A
Total Cases: 951
Not Charted
100%
90%
80%
70%
60%
52%
50%
40%
42%
35%
36%
34%
29%
29%
30%
24%
20%
20%
10%
0%
0%
20%
Key indicators of compliance:




Education
Leadership support
Easy to follow policies
Regular internal collaboration
(Ball, K . 2010)
 To know the risks of surgical
smoke
 To understand the rationale for
smoke management
 To feel empowered to advocate
for smoke evacuation in your OR.
6
 Gaseous toxic compounds
 Bio-aerosols
 Dead and live cellular material (including blood
fragments)
 Viruses
 Carbonized tissue
 Bacteria
 Acrolein
 Benzene
 Carbon Monoxide
 Formaldehyde
 Hydrogen cyanide
 Methane
 Toluene
 Polycyclic aromatic hydrocarbons (PAH)
 Smoke plume and aerosols contain 95% water vapor
 Water vapor itself is not harmful, but acts as a carrier
Human Immunodeficiency Virus
Human Papilloma Virus
Hepatitis B
= 0.15 micron
= 0.055 micron
= 0.042 micron
Surgical Smoke = 0.1-5.0 micron
 Concentration: over 1 million particles/cubic feet
 It takes 20 min after the activation of the ESU for the
concentration to return to the baseline level (Nicola, et
al. 2002).
 Travel at 40 mph
 Evenly distributed throughout
the operating room
“Each year, an estimated 500,000 workers, including
surgeons, nurses, anesthesiologists, and surgical
technologists, are exposed to laser or electrosurgical
smoke.”
Laser/Electrosurgery Plume. Occupational Safety and Health Administration (OSHA) Quick Takes.
United States Department of Labor
http://www.osha.gov/SLTC/laserelectrosurgeryplume/index.html (accessed Dec 5, 2012)
 Using the CO2 laser on one gram of tissue is
like inhaling the smoke from three
cigarettes in 15 minutes.
 Using ESU on one gram of tissue is like
inhaling smoke from six cigarettes in 15
minutes.

(Tomita et al., 1989)
 Eye, nose, throat irritation
 Headaches
 Nausea, dizziness
 Runny nose
 Coughing
 Respiratory irritants
 Fatigue
 Skin irritation
 Allergies
Perioperative staff have
twice the incidence
of many respiratory problems as
compared to the general
population. (Ball, 2010)
Soft contact lenses can absorb toxic gases
produced by surgical smoke.
 Levels of carboxyhemoglobin of patients who
underwent laparoscopic procedures using laser were
significantly elevated. (Ott, 1998)
 Carbon monoxide levels increase in the peritoneal
cavity and exceed recommended exposure limits.
(Beebe et al 1993)
 AORN
 ANSI
 ECRI
 NIOSH/CDC
 OSHA
 Joint Commission
“Potential hazards associated with surgical
smoke generated in the practice setting
should be identified, and safe practices
established.”
Airborne Contaminants:
Shall be controlled by the use of ventilation (ie., smoke
evacuator). Respiratory protection required for any
residual plume escaping capture.
 Recommends the evacuation of surgical smoke
 The content of laser and ESU smoke is very similar
https://www.ecri.org/
 The smoke evacuator or room suction hose
nozzle inlet must be kept within 2 inches of
the surgical site
 The smoke evacuator should be ON
(activated) at all times when airborne
particles are produced
General Duty Clause:
Employer MUST provide a safe
workplace environment!
 The hospital must minimize risks associated with
selecting, handling, storing, transporting, using, and
disposing of hazardous gases and vapors.
 Hazardous gases and vapors include, but are not limited
vapors
generated while using cauterizing
equipment and lasers, and gases such as
to, glutaraldehyde, ethylene oxide,
nitrous oxide.
Strategies for Success
 Communication with Surgeon
and Perioperative Team
members
 Plan for Smoke Evacuation
 Equipment availability
Relevant information
about smoke
evacuation and
equipment used
 Education
 Chart Audits
 Equipment Service Reports
30
Smoke Evacuation Methods
in the Perioperative Setting
 In-line filters
 Smoke evacuator systems
 Laparoscopic filtering devices