A danger that can't be ignored.
Surgical Products: What are the main causes for electrosurgical smoke in the OR?
Vangie Dennis, RN, BSN, CNOR, CMLSO, Administrative Director, Spivey Station Surgery Center, Emory Health System: ESU devices, such as the active tip (electrosurgical pencils). Smoke can be produced by any energy device in the OR. Devices such as ultrasonic scalpels, electrosurgical systems, lasers and drills (create particulates that can be inhaled).
Brenda Ulmer, RN, MN, CNOR, Perioperative Educator: As Vangie has indicated, anything that disrupts tissue can create smoke, plume or mist. Electrosurgery is used more than any other hemostatic device and is the biggest "culprit." Electrosurgery produces the smallest particles with the greatest potential to reach the gas exchange regions of the lungs. Electrosurgery has been used in surgical procedures since the early 1900s so practitioners have a tendency to ignore health hazards associated with the smoke.
SP: How can surgical smoke become dangerous for medical personnel? For patients?
Dennis: The inhalation of the particulates, (over 80 different chemicals) viruses, bacteria, inorganic and organic gases, which are confirmed to be carcinogens as well as the potential transmission of disease.... Particulate sizes are as small as .042 microns and can reach the alveoli of the lungs. The particulate distribution throughout the OR travels at 40 mph, increasing particulates from a baseline of 60,000 to 1 million particles per cubic foot.
Ulmer: Smoke is also dangerous for patients undergoing laparoscopic procedures. As smoke accumulates in the patient's abdomen it can be absorbed through the peritoneal membrane. Once absorbed, the smoke creates methhemoglobin and carboxyhemoglobin in the patient's blood. Those substances knock off the oxygen-carrying capacity of red blood cells.
SP: Do you believe surgical smoke is an overlooked danger in the OR?
Dennis: Yes. Conversion to the standard precautions for the removal of smoke has been a constant issue. OR staff and physicians do not realize the hazards, administration is also not aware of hazards, and if so, evacuators are not purchased stating cost is an issue. Lastly, conversion in the practice setting is difficult as physicians state it interferes with doing surgery.
Ulmer: I agree. An issue is that the effects of smoke can be cumulative and will affect different people in different ways over time. It took more than 50 years for the dangers of cigarette smoke to be recognized with much greater population data on the dangers. Smoke is dangerous for humans to inhale.
SP: What are medical facilities doing to prevent the dangers of surgical smoke?
Dennis: Most are using standard wall suction believing it is adequate. We are seeing a trend as the level of education is delivered where smoke evacuation policies and protocols are set up.
Ulmer: There are also instances where hospitals began smoke evacuation in all surgical and invasive procedures based on Joint Commission recommendations. I was recently told about a major teaching facility in Colorado that started smoke evacuation for that reason. Recommendations from the Joint Commission, however, will vary based on the person doing the survey. Education about the dangers of smoke is one of the major things hospitals can do, along with providing equipment to evacuate and filter the smoke.
SP: Going forward, in what ways do you see medical facilities and suppliers working together to reduce surgical smoke?
Dennis: The easiest way is enculturating the practice where hospital administration, physicians and staff realize this is a standard of care. Hospitals and medical companies need to partner to introduce cost-effective devices and protocols for ease of introduction into the surgical arena.
Ulmer: One of the best ways medical manufactures can assist health care facilities is to make evidence-based, non-commercial education on the dangers of surgical smoke available. The danger of surgical smoke is one issue that should cross all lines because promoting evacuation and filtration is for the greater good of protection for practitioners providing patient care. Hospitals can assist manufacturers by providing information on what works well and what could be improved to support facility-wide smoke evacuation.
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||BRAINSTORM: Electrosurgical Smoke|
|Date:||Jan 1, 2015|
|Previous Article:||Healthmark's Flexible Inspection Scope.|
|Next Article:||Technology solutions serve as the 'engine' in modern OR.|