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Intraoperative Laser Safety Precautions and Endotracheal Fire Control (6.05)

Intraoperative Laser Safety Precautions and Endotracheal Fire Control (6.05) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Safety

6.05

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1987
ORIGINAL
 REVISION

NOVEMBER 2015
PAGE 1
OF 4
POLICY #

6.05
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
INTRAOPERATIVE LASER SAFETY PRECAUTIONS AND
ENDOTRACHEAL FIRE CONTROL



I. PURPOSE

To provide laser safety during each surgical procedure where a laser is being used for treatment and steps to
control an endotracheal fire

II. POLICY

A. Laser safety precautions specific to each type of laser will be followed during laser use. Visual
inspection of laser equipment should be performed by the laser operators during set-up.
B. Protective eyewear will be worn by each individual in the O.R. with appropriate optical density and
wave length for the laser being used.
1. Eye protection for personnel:
a. For the CO2 Laser, wear lenses of an optical density of 5 or greater at 10,600 nm. Wear
glasses or goggles specifically provided for CO2 Lasers over routine eyewear. Routine
eyewear may not have adequate side shields and has not been specifically tested for CO2
Lasers.
b. Laser safety wear color is not a reliable indicator of appropriateness. The wavelength of the
laser must be known and glasses that state they have optical density for greater to that
wavelength must be used. (Laser eyewear is not interchangeable for lasers.)
c. Lasers on hand as of November, 2015 and their treatment beam wavelengths are:
i. CO2 - 10,600 nm
 Lumenis
 Omniguide
ii. Yag - 1,060-1,064 nm
iii. Holmium - 2,100 nm
iv. Diode, red - 810 nm
 Endo Optics
 Iridex
 Diode TTT
v. Diode, green - 532 nm
 Vitra
 Lumenis
 Constellation
vi.
vii. KTP - 532 nm
viii. Pulse Dye Laser - 583-587 nm
 Cynosure Cynergy
 Cynosure Photogenica

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1987
ORIGINAL
 REVISION

NOVEMBER 2015
PAGE 2
OF 4
POLICY #

6.05
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
INTRAOPERATIVE LASER SAFETY PRECAUTIONS AND
ENDOTRACHEAL FIRE CONTROL



ix. Revolix - 2,013 nm

d. The department will provide laser appropriate glasses.
e. Contact lenses and regular prescription glasses are not adequate eye protection.
f. Face masks with attached eye shield are not adequate.
2. Eye protection for the patient.
a. Same as for personnel if procedure is under monitored/regional anesthesia. EXCEPTION is
patients having laser surgery on their eyes.
b. For general anesthesia, tape the patient’s eyes shut, and cover with moist eye pads and a wet
towel, laser eye shields, or laser glasses.
c. Cover the patient’s face with a wet towel over endotracheal tube when doing laser airway
procedures.
d. Have container of water, filled with wet towels in the OR suite.
e. Water filled 60 cc syringe on field for airway cases.
f. Additional pair(s) of laser glasses will be available at all entrances to the Operating Room(s)
outside of the room for personnel to don prior to entering.
C. Signs will be posted on each door entering the Operating Room and on Nurse Server doors.
1. Signs will state:
a. *Danger*
b. Type of laser being used, including treatment beam wavelength (nm)
c. Class IV medical laser
d. Skin and eye protection needed
D. Windows will be completely covered with opaque material when using any lasers. Operating Room
doors should remain closed. Laser in use warning light will be turned on.
E. All instrumentation and exposed surrounding tissue will be protected from potential damage
resulting from reflected laser energy and heat.
1. Cover exposed tissue with wet sponges, laps, cottonoids or towels. Exception: KTP ear probe,
Diode eye probe.
2. Barrier cloth drapes should be used at the operative site rather than chux, etc.
3. Irrigate surrounding tissue PRN to decrease the temperature.
4. Use matte-finish non-reflective or black ebonized instruments.
F. During oral, nasopharyngeal or laryngotracheal surgery, the endotracheal tube will be protected from
combustion.
1. Items with the potential for causing fire, burns, or explosions include:
a. Flammable liquids to include prep solutions or combustible ointments
b. Gases (e.g. oxygen, methane, anesthetic agents, alcohol vapor)
c. Plastics
d. Electrical failures

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1987
ORIGINAL
 REVISION

NOVEMBER 2015
PAGE 3
OF 4
POLICY #

6.05
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
INTRAOPERATIVE LASER SAFETY PRECAUTIONS AND
ENDOTRACHEAL FIRE CONTROL



e. Paper or gauze materials
f. Surgical drapes
g. Adhesive or plastic tapes
h. Endotracheal tubes
2. An appropriate endotracheal tube will be utilized:
a. FIO2 must be 30 or lower.
b. Approved laser-specific endotracheal (ET) tube.
c. Inflate cuff with NaCl (dyed saline).
3. Never use a poly-vinyl chloride tube.
4. Endotracheal fires during laser cases will be controlled by:
a. Terminating all anesthetic gases, including oxygen immediately.
b. Stop ventilation and either disconnect endotracheal tube from breathing circuit or clamp the
tube
c. Remove the endotracheal tube.
d. Extinguish any flames with saline or water.
e. Manage ventilation with a mask, if possible , until it is decided whether to reintubate with an
ET tube or a rigid bronchoscope.
f. Monitor the patient closely post-operatively for a minimum of 24 hours.
i. If necessary, make ICU arrangements
g. If patient injury, follow Policies #4.22 “Event Reporting “and 12.40 “Reporting of Device-
Related Adverse Events and other Product Problems
G. Solutions should not be placed on laser units. Lasers are high voltage equipment and should be
protected against short circuiting associated with spillage or splatter.
H. During rectal procedures, the rectum will be packed with wet counted sponges. Place wet towel over
rectum during vaginal or perineal cases. Close proximity to methane (rectal) flammable gas can
cause an explosion.
I. Use of flammable prep solutions will be avoided (i.e. alcohol, alcohol-based prep solution -
DuraPrep, ChloraPrep).
J. Smoke plume inhalation should be reduced by the use of:
1. High filtration surgical masks (N95 mask)
2. Smoke evacuator units
K. Fumes and smoke created by the laser will be evacuated with a proper suction device.
1. Smoke evacuator units (i.e. Neptune smoke evacuation, Buffalo filter).
2. A heavy duty Hepa-filter evacuator may be necessary during vaporization of large areas or to
evacuate offensive odors.
3. Hold the suction tip as close to the plume as possible.
L. High filtration masks will be worn by all personnel. When laser smoke will be present, all personnel
should wear masks, properly and snugly, with a filtration 95% particles filtration efficiency of .3

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1987
ORIGINAL
 REVISION

NOVEMBER 2015
PAGE 4
OF 4
POLICY #

6.05
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
INTRAOPERATIVE LASER SAFETY PRECAUTIONS AND
ENDOTRACHEAL FIRE CONTROL



(N95) micron particles in order to filter out airborne particles contained in laser plume. Double
masking is not effective.
M. Operator of the laser foot control and all other foot control devices will be limited to the surgeon
using the device. This will prevent inadvertent firing of the laser and other devices.
N. The laser will be kept in stand-by mode when not being used.
1. This may include:
a. Adjusting laser settings
b. Between application of laser treatment
c. Switching laser operators
d. Following safety check and prior to use on patient (when not in use)
O. The laser hand piece and fiber will be kept in a wet towel when not in use.
P. The applicable information for each laser is documented in the OpTime log.
1. Type of laser
2. Power setting
3. Safety measures
Q. Nursing staff operating the laser will have demonstrated competency or have a resource person
available. In the situation where the demands on the OR team exceeds the ability to attend to safe
operation of the laser, additional assistance will be requested and provided.
R. Surgeons operating the laser will have laser privileges.


III. REFERENCE

AORN Standards Recommended Practices Guidelines 2015

REVIEWED BY

Jennifer Ballard, Surgical Services Supervisor 11/2015
Suzanne Morris, Clinical Nurse Manager, AFCH OR 11/2015
Trisca Parrell, Surgical Services Supervisor 11/2015
Surgical Services Policy and Procedure Committee 11/5
Debra Zink, Surgical Services Supervisor 11/2015
Dr. Jeffrey Lee, Medical Director, Outpatient Surgical Services 11/2015
Dr. Christopher Turner, Anesthesia Department, 11/2015



SIGNED BY


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1987
ORIGINAL
 REVISION

NOVEMBER 2015
PAGE 5
OF 4
POLICY #

6.05
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
INTRAOPERATIVE LASER SAFETY PRECAUTIONS AND
ENDOTRACHEAL FIRE CONTROL



Jeff Fenne, MSN, RN
Director, Surgical Services Department