0107Laser Safety. 0107Laser Safety Laser Safety Objectives Describe basic safety using lasers in the...
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Transcript of 0107Laser Safety. 0107Laser Safety Laser Safety Objectives Describe basic safety using lasers in the...
01070107 Laser SafetyLaser Safety
Laser Safety ObjectivesLaser Safety Objectives Describe basic safety using lasers in the Describe basic safety using lasers in the
operating room.operating room. Explain steps to prevent eye injury during laser Explain steps to prevent eye injury during laser
use.use. Determine when laser safety glasses are worn Determine when laser safety glasses are worn
by OR personnel.by OR personnel. Describe how to prevent fire when using lasersDescribe how to prevent fire when using lasers Classify three laser endotrachael tubes used at Classify three laser endotrachael tubes used at
VUMCVUMC
01070107 Laser SafetyLaser Safety
Education is the Key to Safe Education is the Key to Safe Laser UseLaser Use
Surgeons complete:Surgeons complete: Didactic lecture on both laser and clinical Didactic lecture on both laser and clinical
applications.applications. Hands-on experience with laboratory Hands-on experience with laboratory
models.models. Preceptorship with experienced operatorsPreceptorship with experienced operators Residency training in University HospitalsResidency training in University Hospitals
01070107 Laser SafetyLaser Safety
Staff EducationStaff EducationSupport staffSupport staff
Didactic lecture on basic laser physics Didactic lecture on basic laser physics and laser safetyand laser safety
Operational training with return Operational training with return demonstrationdemonstration
Candela Laser Holmium/YAG Laser CO2 Lasers YAG/KTP Laser
01070107 Laser SafetyLaser Safety
Injuries and PreventionInjuries and Prevention
Types of injuries to staff membersTypes of injuries to staff members Eye injuriesEye injuries Skin injuriesSkin injuries
Injury to patientsInjury to patients Preventative measuresPreventative measures
01070107 Laser SafetyLaser Safety
Eye SafetyEye Safety
Unprotected eyes Unprotected eyes can become can become injured in two injured in two placesplaces CorneaCornea RetinaRetina
CorneaRetina
Staff member with corneal injury from not wearing laser safety glasses
Safety Alert:
All safety eyewear must be wavelength specific for each laser regardless of color.
Laser SafetyLaser Safety
Staff SafetyStaff Safety
Warning signs should be placed on Warning signs should be placed on all doors leading to the OR.all doors leading to the OR.
Laser SafetyLaser Safety
Staff SafetyStaff Safety
Always place eye protection on all Always place eye protection on all doors leading into the operating doors leading into the operating room.room.
Laser SafetyLaser Safety
Eye SafetyEye Safety
For both open & closed procedures: For both open & closed procedures: appropriate eye protection is appropriate eye protection is required for all viewers within the required for all viewers within the nominal hazardnominal hazard zone. zone.
The The nominal hazardnominal hazard zone is zone is considered to be the procedure considered to be the procedure room.room.
Laser SafetyLaser Safety
Patient SafetyPatient Safety Patient Precautions for anesthetized Patient Precautions for anesthetized
C02 laser patientC02 laser patient Eyes taped and lubricatedEyes taped and lubricated Saline saturated eye pads taped to faceSaline saturated eye pads taped to face
The awake patient may wear The awake patient may wear wavelength specific laser goggles.wavelength specific laser goggles.
Laser SafetyLaser Safety
Eye SafetyEye Safety
Eyes may be protected with wavelength Eyes may be protected with wavelength specific goggles (Argon, Dye, KTP, specific goggles (Argon, Dye, KTP, Nd:Yag)Nd:Yag)
Eyes may be shielded with saline soaked Eyes may be shielded with saline soaked sponges covered by Aluminum foil if the sponges covered by Aluminum foil if the wavelength specific goggles interfere wavelength specific goggles interfere with surgery.with surgery.
Laser SafetyLaser Safety
Prevention of Eye InjuryPrevention of Eye Injury CO2 laserCO2 laser Requires wavelength specific glasses Requires wavelength specific glasses
or goggles with side guardsor goggles with side guards Optics of operating microscope Optics of operating microscope
protects the surgeonprotects the surgeon
Laser SafetyLaser Safety
Prevention of Eye InjuryPrevention of Eye Injury All wavelength lasers:All wavelength lasers:
Require wavelength specific Require wavelength specific glasses/goggles with side guardsglasses/goggles with side guards
Surgeon wears glasses or usesSurgeon wears glasses or uses special special filter lens on all scopesfilter lens on all scopes
All wavelength Lasers require all viewing All wavelength Lasers require all viewing windows to be covered/closed except for windows to be covered/closed except for the CO2.the CO2.
Laser SafetyLaser Safety
Skin InjuriesSkin Injuries
Laser light can be reflected off any Laser light can be reflected off any shiny surface causing a variety of shiny surface causing a variety of skin injuries.skin injuries.
Laser SafetyLaser Safety
Prevent Laser Light Prevent Laser Light ReflectionReflection
Use ebonized or dull finished Use ebonized or dull finished instrumentsinstruments
Modified laryngoscopes and Modified laryngoscopes and bronchoscopesbronchoscopes
Special microlaryngeal instrumentsSpecial microlaryngeal instruments
Laser SafetyLaser Safety
PlumePlume Lasers produce plume (smoke) Lasers produce plume (smoke)
containing hazardous components containing hazardous components which may cause eye, nose and which may cause eye, nose and throat irritation as well as nausea, throat irritation as well as nausea, vomiting, and flu-like symptoms. vomiting, and flu-like symptoms.
HPV has been isolated in CO2 plumeHPV has been isolated in CO2 plume All staff should wear PPEs, including All staff should wear PPEs, including
special high filtering laser masksspecial high filtering laser masks
Laser SafetyLaser Safety
Adequate Plume (Smoke) Adequate Plume (Smoke) EvacuationEvacuation
Double suction set-upDouble suction set-up Place disposable filters in suction Place disposable filters in suction
lineslines Use a separate smoke evacuator Use a separate smoke evacuator
with disposable filter and tubingwith disposable filter and tubing
Filter
Laser SafetyLaser Safety
Fire PreventionFire Prevention
Airway Airway Non-combustible endotrachael tubesNon-combustible endotrachael tubes
Laser SafetyLaser Safety
Laser Endotrachael TubesLaser Endotrachael Tubes
These are examples of wrapped red These are examples of wrapped red rubber reusable endotracheal tubes which rubber reusable endotracheal tubes which are rarely used due to problems with are rarely used due to problems with unwrapping during extubation. Tubes unwrapping during extubation. Tubes wrapped with metal tape to reflect laser wrapped with metal tape to reflect laser lightlight
Rarely used in pediatric airway casesRarely used in pediatric airway casesIllustrates how a laser can damagea metal wrapped ET tube
Laser SafetyLaser Safety
Laser Endotrachael TubesLaser Endotrachael Tubes Xomed Lasershield-AdultsXomed Lasershield-Adults
Use with CO2 and KTP airway casesUse with CO2 and KTP airway cases Cuff is inflated with methylene blueCuff is inflated with methylene blue Cottonoids are packed around cuffCottonoids are packed around cuff
If cuff is hit with laser light, it punctures the If cuff is hit with laser light, it punctures the cuffcuff
Methylene blue leaks onto cottonoids Methylene blue leaks onto cottonoids alerting staff of damaged cuff.alerting staff of damaged cuff.
Cottonoids
Methelene blue
Laser SafetyLaser Safety
Laser EndotrachaelLaser Endotrachael
Lasertubus Endotrachael Tube-AdultsLasertubus Endotrachael Tube-Adults Used for airway procedures with the Used for airway procedures with the
Nd:YAG laserNd:YAG laser
Laser SafetyLaser Safety
Nursing Considerations for Fire Nursing Considerations for Fire PreventionPrevention
Always use non-flammable prep Always use non-flammable prep agentsagents
Always keep a bowl/syringe of sterile Always keep a bowl/syringe of sterile saline/water on the back table to saline/water on the back table to extinguish a fireextinguish a fire
Always use moist towels to drape Always use moist towels to drape surgical area for open proceduressurgical area for open procedures
Laser SafetyLaser Safety
Nursing ConsiderationsNursing Considerations
Always use moist sponges around Always use moist sponges around the operative area when indicatedthe operative area when indicated
Keep the floor dry around the laserKeep the floor dry around the laser Avoid placing liquids on top of laserAvoid placing liquids on top of laser
Laser SafetyLaser Safety
Pre-procedure testing for Pre-procedure testing for LasersLasers
Laser will be test fired (CO2) and/or Laser will be test fired (CO2) and/or calibrated prior to the patient calibrated prior to the patient entering the OR.entering the OR.
If laser does not function properlyIf laser does not function properly Obtain another laser of the same Obtain another laser of the same
wavelengthwavelength Notify attending physician if no other Notify attending physician if no other
laser is availablelaser is available
010010 Laser SafetyLaser Safety
Anesthesia ConsiderationsAnesthesia Considerations Jet ventilation as an alternative to Jet ventilation as an alternative to
intubation.intubation. To reduce risk of fire in cases To reduce risk of fire in cases
involving the oral cavity, head or involving the oral cavity, head or neck, a maximum gas mixture of neck, a maximum gas mixture of 40% oxygen & 60% helium must be 40% oxygen & 60% helium must be used. used.
Connects to O2 wall port
Gage to measure pressure
Delivery device
Laser SafetyLaser Safety
Airway FireAirway Fire When ignition occursWhen ignition occurs
Disconnect oxygen supplyDisconnect oxygen supply Flood area with water or salineFlood area with water or saline
Immediately extubate the patientImmediately extubate the patient Secure a new airwaySecure a new airway
Oral airwayOral airway Reintubate with smaller cuffed or uncuffed Reintubate with smaller cuffed or uncuffed
ET tubeET tube
Laser SafetyLaser Safety
Safety ConsiderationsSafety Considerations Surgeon directing the laser energy, Surgeon directing the laser energy,
should be in control of the foot pedal.should be in control of the foot pedal. Place laser on stand-by each time Place laser on stand-by each time
the surgeon takes his/her foot off the the surgeon takes his/her foot off the foot pedalfoot pedal
Check all electrical components of Check all electrical components of laser before plugging unit into wall.laser before plugging unit into wall.
STANDBY
Please…
…the laser is in STANDBY, Doctor
Laser SafetyLaser Safety
Laser DocumentationLaser Documentation
Document which laser is usedDocument which laser is used Safety measures are takenSafety measures are taken Time laser is usedTime laser is used Document in OR nursing record and Document in OR nursing record and
Laser Log if unit requiresLaser Log if unit requires
Laser SafetyLaser Safety
Troubleshooting GuideTroubleshooting Guide
1.1. Check power sourceCheck power source
2.2. Check all connectionsCheck all connections
3.3. Turn laser off and back onTurn laser off and back on
4.4. Call charge nurse of the service lineCall charge nurse of the service line
5.5. Call Unit Laser Safety OfficerCall Unit Laser Safety Officer