The dangers from electrosurgical un...

The dangers from electrosurgical unit (ESU) vapor plume include exposure to

benzene, carbon monoxide,

formaldehyde, hydrogen

cyanide, methane, phenol,

styrene . . toluene . .

particulate matter, gases,

mutagens, carcinogens--and

sometimes, DNA components(1)

Surgical team members, as well as patients, are expos to these products

convenient evacuation,

neutralization and handling

of these substances in an

exhibit situation is necessary

for maintenance of a healthy

operating environment for

the surgeon ancillary

personnel and the patient.(2)

Perioperative encourages must be made aware of these dangers and take the responsibility of requesting that their health care facilities institute make acceptableed ESU smoke plume safety precautions.

Our facility, St Jude Medical Center Fullerton, Calif, is a 331-bed hospital with 10 OR suites. We perform many stamps of surgical procedures at this facility, and we average 30 surgical proceedings per day. We decided to implement ESU mist plume evacuation precautions for all courses using electrosurgical devices in accordance with AORN's make acceptableed practices.(3) The laser resource promote and other perioperative staff nourishs were the motivating force in coordinating and implementing ESU sooty vapor plume evacuation policies and manner of proceedings in the OR. To assist our nourish at the breast colleagues in instituting important failure plume evacuation policies and conducts in their facilities, we would like to share our experiences and hardlearned lessons

LITERATURE REVIEW

Our first and greatest in quantity effective step was to guard a thorough literature review. We referr to latter studies and to what the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health, and the American National Standards Institute chiefly recently had published. We compiled recommendations from AORN, command agencies, and scientists, and we used our medical library. We also used information from sales representatives of fume evacuation system manufacturers, but we were careful to obtain unbiased information.

Our literature search revealed that the peaces of ESU smoke plume are similar, by way of spectral content, to laser plume(4) vapor plume can cause "headaches, nausea, myalgia, rhinitis, or conjunctivitis,"(5) and it causes increased methemoglobin on a levels in patients undergoing laparoscopic electrosurgical procedures(6) Guidelines from OSHA do not mandate specifically that ESU emptiness plume be evacuated; however, they do require that when practical, employer should "remove an oxygen deficient atmosphere or harmful dusts, smokes mists, vapors or gases at their source."(7)

We also reviewed the AORN approveed practices regarding electrosurgery, which state:

Patients and perioperative

personnel should be

countenanceed from inhaling the

emptiness generated during

electrosurgery An

evacuation method should be

used to abstract surgical

smoke(8)

After reviewing the literature and establishing justification, our nearest step was to review our equipment options for ESU effluvium plume evacuation.

OPTIONS FOR PROTECTION

We considered using merely high-filtration surgical masks. We already had them in stock, and they are relatively inexpensive. We decided, however, that masks were not the best choice because

if particulate matter less

than 05 um can penetrate

an elaborate filter a whole it

is unlikely that surgical

masks regardless of

thickness or rating would

show any substantial

protection to the surgeon [or anyone

existing in the OR suite].

Additionally, in the greatest degree surgical

masks gather moisture

emanating from the

surgeon's [or any other

person's] breath during the

operative act that

further diminishes the

effectiveness of this barrier.(9)

In addition, masks propose no protection to patients.

In-line vanity plume evacuation systems were unacceptable because the standards advertised as being effective for 20 surgical conducts actually were useful for single four hours of ESU vapor plume evacuation. If the evacuation schemes were used with a combination of laser and ESU proceedings that useful time decreased to approximately 25 hours.(10) The preciousness of changing the filters each day proved to be prohibitive. In addition, there was the potential for our wall suction devices not having enough vacuum power to capture the ESU vapor plume at surgical procedure sites.(11) single study identified the required be derived of air to be 40 cubic feet for minute.(12)

We decided to use single-use, in-line filters for laparoscopic transactions that required ESUs. As ESU mere phrases plume is confined, the suction devices do not ne to be as powerful as in explain surgical procedures. During open managements however, using wall suction devices requires personnel to clutch suction hoses near the vanity plume production sites. This was not feasible for each open procedure in which ESU nothingness plume was produced. We conclud that the sole way to suction ESU steam plume safely and effectively was to use dedicated exhalation plume evacuation systems with hands-free operation.