01070107 Laser SafetyLaser Safety

Laser Safety

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