Management of Surgical Smoke in the Perioperative Setting
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Transcript of Management of Surgical Smoke in the Perioperative Setting
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Management of Surgical Smoke
in the Perioperative
Setting
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44-year old surgeon developed laryngeal papillomatosis
Biopsy identified the same virus type as anogenital condyloma
Hallmo, et al (1991)
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Total Cases: 951
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Key indicators of compliance:EducationLeadership supportEasy to follow policiesRegular internal collaboration
(Ball, K . 2010)
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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.
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Gaseous toxic compoundsBio-aerosolsDead and live cellular material (including
blood fragments)Viruses Carbonized tissueBacteria
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Acrolein BenzeneCarbon MonoxideFormaldehydeHydrogen cyanideMethaneToluenePolycyclic aromatic hydrocarbons (PAH)
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Smoke plume and aerosols contain 95% water vapor
Water vapor itself is not harmful, but acts as a carrier
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Human Immunodeficiency Virus = 0.15 micronHuman Papilloma Virus = 0.055 micronHepatitis B = 0.042 micron
Surgical Smoke = 0.1-5.0 micron
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Concentration: over 1 million particles/cubic feetIt 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
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“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)
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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)
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Eye, nose, throat irritation
HeadachesNausea, dizzinessRunny noseCoughingRespiratory irritantsFatigueSkin irritationAllergies
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Perioperative staff have
twice the incidence
of many respiratory problems as compared to the general
population. (Ball, 2010)
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Soft contact lenses can absorb toxic gases produced by surgical smoke.
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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)
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AORNANSIECRI
NIOSH/CDCOSHA
Joint Commission
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“Potential hazards associated with surgical smoke generated in the practice setting should be identified, and safe practices established.”
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Airborne Contaminants:Shall be controlled by the use of ventilation
(ie., smoke evacuator). Respiratory protection required for any residual plume escaping
capture.
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Recommends the evacuation of surgical smoke
The content of laser and ESU smoke is very similar
https://www.ecri.org/
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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
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General Duty Clause:
Employer MUST provide a safe workplace
environment!
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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 to, glutaraldehyde, ethylene oxide,
vapors generated while using cauterizing equipment and lasers, and gases such as nitrous oxide.
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Strategies for Success
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Communication with Surgeon and Perioperative Team members
Plan for Smoke Evacuation
Equipment availability
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Relevant information about smoke evacuation and equipment used
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EducationChart AuditsEquipment Service Reports
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Smoke Evacuation Methodsin the Perioperative Setting
In-line filtersSmoke evacuator systems
Laparoscopic filtering devices