Describe basic safety using lasers in the operating room. Describe basic safety using lasers in the operating room



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Describe basic safety using lasers in the operating room.

  • Describe basic safety using lasers in the operating room.

  • Explain steps to prevent eye injury during laser use.

  • Determine when laser safety glasses are worn by OR personnel.

  • Describe how to prevent fire when using lasers

  • Classify three laser endotrachael tubes used at VUMC



Surgeons complete:

  • Surgeons complete:

    • Didactic lecture on both laser and clinical applications.
    • Hands-on experience with laboratory models.
    • Preceptorship with experienced operators
    • Residency training in University Hospitals


Support staff

  • Support staff

    • Didactic lecture on basic laser physics and laser safety
    • Operational training with return demonstration


Types of injuries to staff members

  • Types of injuries to staff members

  • Injury to patients

  • Preventative measures



Unprotected eyes can become injured in two places

  • Unprotected eyes can become injured in two places

    • Cornea
    • Retina


Warning signs should be placed on all doors leading to the OR.

  • Warning signs should be placed on all doors leading to the OR.



Always place eye protection on all doors leading into the operating room.

  • Always place eye protection on all doors leading into the operating room.



For both open & closed procedures: appropriate eye protection is required for all viewers within the nominal hazard zone.

  • For both open & closed procedures: appropriate eye protection is required for all viewers within the nominal hazard zone.

  • The nominal hazard zone is considered to be the procedure room.



Patient Precautions for anesthetized C02 laser patient

  • Patient Precautions for anesthetized C02 laser patient

  • The awake patient may wear wavelength specific laser goggles.



Eyes may be protected with wavelength specific goggles (Argon, Dye, KTP, Nd:Yag)

    • Eyes may be protected with wavelength specific goggles (Argon, Dye, KTP, Nd:Yag)
    • Eyes may be shielded with saline soaked sponges covered by Aluminum foil if the wavelength specific goggles interfere with surgery.


CO2 laser

  • CO2 laser

  • Requires wavelength specific glasses or goggles with side guards

  • Optics of operating microscope protects the surgeon



All wavelength lasers:

  • All wavelength lasers:

    • Require wavelength specific glasses/goggles with side guards
    • Surgeon wears glasses or uses special filter lens on all scopes
    • All wavelength Lasers require all viewing windows to be covered/closed except for the CO2.


Laser light can be reflected off any shiny surface causing a variety of skin injuries.

  • Laser light can be reflected off any shiny surface causing a variety of skin injuries.



Use ebonized or dull finished instruments

  • Use ebonized or dull finished instruments

  • Modified laryngoscopes and bronchoscopes

  • Special microlaryngeal instruments



Lasers produce plume (smoke) containing hazardous components which may cause eye, nose and throat irritation as well as nausea, vomiting, and flu-like symptoms.

  • Lasers produce plume (smoke) containing hazardous components which may cause eye, nose and throat irritation as well as nausea, vomiting, and flu-like symptoms.

  • HPV has been isolated in CO2 plume

  • All staff should wear PPEs, including special high filtering laser masks



Double suction set-up

  • Double suction set-up

  • Place disposable filters in suction lines

  • Use a separate smoke evacuator with disposable filter and tubing



Airway

  • Airway

    • Non-combustible endotrachael tubes


These are examples of wrapped red rubber reusable endotracheal tubes which are rarely used due to problems with unwrapping during extubation. Tubes wrapped with metal tape to reflect laser light

  • These are examples of wrapped red rubber reusable endotracheal tubes which are rarely used due to problems with unwrapping during extubation. Tubes wrapped with metal tape to reflect laser light

  • Rarely used in pediatric airway cases



Xomed Lasershield-Adults

  • Xomed Lasershield-Adults

    • Use with CO2 and KTP airway cases
    • Cuff is inflated with methylene blue
    • Cottonoids are packed around cuff
      • If cuff is hit with laser light, it punctures the cuff
      • Methylene blue leaks onto cottonoids alerting staff of damaged cuff.


Lasertubus Endotrachael Tube-Adults

  • Lasertubus Endotrachael Tube-Adults

  • Used for airway procedures with the Nd:YAG laser



Always use non-flammable prep agents

  • Always use non-flammable prep agents

  • Always keep a bowl/syringe of sterile saline/water on the back table to extinguish a fire

  • Always use moist towels to drape surgical area for open procedures



Always use moist sponges around the operative area when indicated

  • Always use moist sponges around the operative area when indicated

  • Keep the floor dry around the laser

  • Avoid placing liquids on top of laser



Laser will be test fired (CO2) and/or calibrated prior to the patient entering the OR.

  • Laser will be test fired (CO2) and/or calibrated prior to the patient entering the OR.

  • If laser does not function properly

    • Obtain another laser of the same wavelength
    • Notify attending physician if no other laser is available


Jet ventilation as an alternative to intubation.

  • Jet ventilation as an alternative to intubation.

  • To reduce risk of fire in cases involving the oral cavity, head or neck, a maximum gas mixture of 40% oxygen & 60% helium must be used.



When ignition occurs

    • When ignition occurs
      • Disconnect oxygen supply
      • Flood area with water or saline
    • Immediately extubate the patient
    • Secure a new airway
      • Oral airway
      • Reintubate with smaller cuffed or uncuffed ET tube


Surgeon directing the laser energy, should be in control of the foot pedal.

  • Surgeon directing the laser energy, should be in control of the foot pedal.

  • Place laser on stand-by each time the surgeon takes his/her foot off the foot pedal

  • Check all electrical components of laser before plugging unit into wall.



Document which laser is used

  • Document which laser is used

  • Safety measures are taken

  • Time laser is used

  • Document in OR nursing record and Laser Log if unit requires



Check power source

  • Check power source

  • Check all connections

  • Turn laser off and back on

  • Call charge nurse of the service line

  • Call Unit Laser Safety Officer



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