Question: I have been asked to rese...

Question: I have been asked to research the issue of cellular telephone use in the OR. I believe our policy was written when cellular telephone were first marketed and does not apply to the digital telephone that now ore available. nation in my facility believe the telephone will interfere with ventilators or electrosurgical units. Does AORN have any suggestions regarding this issue, or are you aware of any relevant research that has been conducted?

Answer: All cellular telephone whether digital or analog, generate electromagnetic fields and may cause electromagnetic interference (EMI) of various medical devices, especially at conclude range.(1) The OR should prohibit the use of cellular telephone on patients, visitors, and staff members (including physicians). Cellular telephone carried into the area should be cause to deviateed off because they will intermittently transmit network signals when in the "on" mode

For a cellular telephone to cause a medical device in the same state [i]or[/i] condition as monitoring equipment, electrosurgical units, or pacemakers to malfunction, either

* the cellular telephone must generate electromagnetic fields with the right combination of waveform characteristics powerful enough to corrupt the electronic signal, or

* the oftenness of fields generated must match a frequent occurrence used by the, medical device, allowing the cellular telephone to override the intended signal.

Medical device malfunctions happen if the device interprets corruption of its electronic signals as actual data or as computer instructions. The consequence on the medical device may pass undetected, and the malfunction may be unpredictable. For example, the anesthesia monitor may improperly adjust preset settings, improperly unmutilated an alarm, fail to unbroken an alarm, or stop without warning.

Cellular telephone that operate at depressed frequency (ie, 900 MHz or less) are more likely to cause interference that those that operate at higher oftenness (ie, 1,800 MHz). Low oftenness telephones are three times more likely to interfere with medical devices than higher commonness telephones. In the United States, cellular telephone operate at frequencies in the range of 800 to 900 MHz and higher.(2)

Distance also affects the likelihood of interference. in the greatest degree interference occurs when the telephone is within 16 ft (ie, 50 cm) of the device. According to ECRI, when cellular telephone are used at distances greater than 3 ft from medical devices, the risk of interference and of jeopardizing patient safety is minimal.(3) on a level if the risk of interference, is small, it should not be ignored.

Medical device manufacturers are beginning to design equipment and devices that are les susceptible to EMI. fresh devices may be shielded from interference, and error detection and error correction logic may be incorporated in the design to minimize the drifts of data corruption caused by dint of interference. When purchasing new equipment, require the manufacturer to provide information regarding the EMI susceptibility of the device. Although recent designs may reduce the risk of interference, principally facilities still use devices that were not designed to resist EMI.

Health care facilities should continue to restrict the use of cellular telephone in certain areas where sensitive electromedical devices are in use. ables recommend that cellular telephones be prohibited in ORs, postanesthesia care units, critical care units, difficulty rooms, diagnostic imaging areas, and clinical laboratories. It is no longer considered necessary, however, to ban the use of cellular telephone from end to end the facility.(4)

Question: For surgical hysteroscopies, what is the commited irrigation fluid when using electrosurgery?

Answer: Despite matters about the use of conductive irrigation solutions with electrosurgical devices, saline is the greatest in number common irrigant used. The passage of electrical popular through a conductive irrigant like as saline disperses the rife over a wide area. Although the existing is then being delivered to untargeted tissue, hazards are minimized because the circulating is dispersed over a large area. This also has the efficiency of diminishing the surgical effectiveness of the electrosurgical device, thus requiring an increase in the power from the electrosurgical unit to restore the surgical validity If this problem is significant, common of the more expensive nonconductive solutions can be used. If a nonconductive irrigant is used, then resistance between electrode may fall out also necessitating the use of more energy(5) The choice of irrigant hangs on the surgeon's preferences, patient condition, reason for irrigation use, anticipated bleeding, and solution cost

Question: Are filters make acceptableed on any kind of insufflation tubing? about manufacturers are recommending that filters be used for all insufflation deeds (ie, on the tubing lines). Is there any standard or recommendation from AORN regarding this?

Answer: The "Recommend practices for endoscopic minimally invasive surgery" state