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LaserPhysicsandSafetyinSurgery

Protecting our patients Protecting others

Protecting ourselves Cindy Caton RN, BSN Interim Clinical Educator, Perioperative Services February 2012

Bytheendofthispresenta0on,learnerwillbeableto:

1.  Definethecharacteris/csoflaserlightand

howitaffectstarget/ssue.2.  Iden/fythecomponentsofalasersystem.3.  Explainthebenefitsoflasertechnologyasit

isusedinsurgery.4.  Iden/fycommonlyusedlasersintheOR.5.  Describesafetyprecau/onsthatmustbe

prac/cedwhenusinglasers.

Introduc0on

LASERisanacronymthatdescribesaprocessinwhichlightenergyisproduced

•  L-light•  A-amplifica/onby

•  S-s/mulated

•  E-emissionof

•  R-radia/on

Laser Safety in Surgery(February 2012) 3

Lightisaformofelectromagne/cenergythatcanbeillustratedonacon/nuumknownastheelectromagne/cspectrum.


Characteris0csofLaserlight

Monochroma0c-lightiscomposedofphotonsofthesamewavelengthorcolor.Incontrast,ordinarylightconsistsofmanydifferentcolorsorwavelengths.Collimated-consistsofwavesparalleltoeachother,whichallowslighttobefocusedintoa/nyspotthathighlyconcentratestheenergy.Coherent-allthewavesareorderlyandtravelinthesamedirec/on,givinglaserbeampower.

Laser Safety in Surgery (Feb 2012) 5

TissueInterac0onWhenlaserenergyisdeliveredtoatargetsite,fourdifferentinterac/onscanoccur:Reflec0on-thedirec/onofthebeamischangedaJeritcontactsanarea.Sca9ering-beamspreadsoveralargeareaas/ssuecausesthebeamtodisperse.Transmission-beampassesthroughfluidsor/ssuewithoutthermallyaffec/ngthearea.Absorp0on-/ssueisalteredfromtheabsorp/onofthebeam.

Laser Safety in Surgery (Feb 2012) 6

Fivemajorcomponentsoflasersystem:Laserhead-componentinwhichlaserenergyisgeneratedandamplified.Containstheac/vemediumthatgenerateslaserlight.Excita0onsource-suppliestheenergytoexcitetheac/vemediuminthelaserhead.Ancillarycomponents-otherlaserpartsneededtohelpproducelaserenergy(i.e.coolingsystem)Controlpanel-regulatesdeliveryoflaserenergyDeliverysystem-devicethatconductslaserenergyfromthelaserheadtotargetsource.


AncillaryComponents

ControlPanel


Laserhead

Delivery System

Totargetsource

Excita/onSource

Parts of a laser system

Benefitsoflasertechnology:1.Sealssmallbloodvessels-lessbloodloss2.Sealslympha/cs-decreasespost-opedema3.Sealsnerveendings-decreasespost-oppain4.Lessscarring-decreasespost-opstenosis5.Reducesopera/veandanesthesia/me6.Providesquickerrecovery


Commonlyusedlasersinsurgery:CO2-•  Usesapremixedgasofcarbondioxide,heliumandnitrogenastheac/vemedium.

•  Highlyabsorbedbywater•  Thedegreeof/ssueresponseisrelatedtotheamountofheatbuildupfromabsorp/onofCO2beam

•  Beamisdeliveredtotargetsitethroughanar/culatedarmorlaserfiber

•  CommonlyusedinENTandGYNprocedures



Holmium:YAG-•  Crystalisthelasersource•  Highlyabsorbedbywater•  Canbeconductedtotarget/ssuethroughaflexiblefiber

•  Producesavaporbubblethattransmitslaserenergywithinashortdistance

•  Commonlyusedinurology


Argon-•  Visiblelaserbeamwithblue-greenlight•  Highlyabsorbedbypigmented/ssue•  Laserenergyisconvertedtoheat,causingcoagula/onorvaporiza/on

•  Deliveredtotargetsitethroughfiberorslit-lamp

•  CommonlyusedinENTandOphthalmology


KTP-•  Beamiscolorselec/veandhighlyabsorbedbyhemoglobinandmelanin

•  Producesanintensegreenlaserlight•  Wavelengthcanbethroughclearsolu/onsandstructures

•  Beamisconductedto/ssuethroughafiber•  CommonlyusedinNeurootology


Diode(980)-•  CommonlyusedintreatmentofBPH•  Laserenergycanbedelivereddirectlyto/ssuethroughafiber

•  Highlyabsorbedinbothwaterandhemoglobin

•  Providesanearbloodlessprocedurethroughbothcu_ngandcoagula/onof/ssue

Lasersystemsarecapableofconcentra0nghighamountsofenergywithinverysmall

areas,whichcanpresenthazards.Healthcarefacili0esarerequiredtohaveacomprehensivelasersafetyprogramin

place.


Thelasersafetyprogramincludes:1.Iden/fica/onoflaserhazardsandcontrolmeasures2.Annuallasersafetyeduca/onandcompetencytes/ngofassociates3.Managementandrepor/ngofaccidentsorincidentsrelatedtolaserprocedures4.Laserserviceandpreven/vemaintenance


ALLLASERSMUSTBETESTEDANDAPPROVEDBYBIOMEDPRIORTOUSEIN

SURGERY.


Generalsafetyprecau0onsEyeprotec0on-•  Theeyeisextremelysensi/vetolaserradia/onandmustbeadequatelyprotectedduringlasersurgery.

•  Everyoneinnominalhazardzonemustwearprotec/veeyewearorusefiltersofspecificwavelengthandop/caldensityforlaseruse

•  Pa/entsmustbeappropriatelyprotected(gogglesorglasses,moistenedeyepads,eyeshields)dependingontypeoflaserused



Smokeevacua0on-•  Removesharmfulplumeduringsurgicalprocedures

•  Shouldbeheldcloseto/ssueinterac/onsitetoremoveasmuchplumeaspossible

•  Filtersmustbechangedaccordingtomanufacturer’sinstruc/ons

Skinprotec0on-•  Thedistal/pofthelaserfibershouldbedirectedatthetarget/ssuetopreventexposureonunprotectedskin

LaserOperator:•  Requireaddi/onalcompetencytraininginaddi/ontoannuallasersafetyin-services

•  Lasermustbetestedbyoperatorpriortopa/entroomadmission

•  Allsafetyequipmentmustbeinspectedandavailabletopa/ent,procedurestaffandonanyentrancestoprocedureroom

•  RoomentrancesmustbeRESTRICTEDwithwarningsignsposted,andwindowscoveredpriortouse

•  Anycomplica/onsorissuesregardinglaserusemustbeimmediatelycommunicatedtochargenurse


LaserProcedureguidelines:

Circulatorroles: •  Knowledgeableofprecau/onsforeach

par/cularlaser•  Dispensessterilewaterorsalinetoopera/vefield

•  Flammableprepsarenottobeused•  Ensurespa/entsafetythroughoutprocedure•  Documentsdetailsregardinglaseruseinmeditech


Scrubroles: •  Knowledgeableofprecau/onsforeach

par/cularlaser•  Sterilewaterorsalineshouldbereadilyavailableonthefield

•  Spongesortowelsnearthetargetsiteshouldbekeptwet

•  Instrumentsusedinthevicinityoflasertreatmentshouldbenonreflec/ve

•  Thewhereaboutsofthelaserismonitoredatall/mes

Laser Safety in Surgery(February 2012)

22

AnesthesiaandLasers: •  PVCEndotrachealtubes(ETTs)arehighlyflammable,

especiallywhenusingO2duringanesthesiaadministra/on

•  Laser-retardantETTsshouldbeusedduringoral,trachealoresophageallaserprocedures

•  ETTsshouldbeinflatedwith/ntedsaline•  Nonexplosivegasesshouldbeusedduringlaseprocedures

•  Incaseofendotrachealfire:–  Stopven/la/on,disconnectgasflow–  Ex/nguishallflameswithsaline–  RemoveETT–  Ven/latepa/entbymaskorreintubate–  Examinetheairwayforburnsorforeignbodies


Firesafetyprotocols:•  Ensuresterilewaterorsalineisimmediatelyavailableonthefieldtodousesmallfire

•  Knowloca/onofandhowtooperatelaser-appropriatefireex/nguisher

•  Usewettowels,nonflammabledrapesnearthelasertargetarea

•  Donotuseflammablematerialsnearthelaserimpactsite

•  Allowflammableskinprepstothoroughlydry•  Onlyac/vatethelaserwhenthedelivery/piswithintheuser’sdirectfieldofvision


IMPORTANTKEENAWARENESSTOTHESURGICALFIELDISKEYINPREVENTINGALASERINDUCEDPROCEDURALFIRE.

USECURRENTFIRESAFETYPROTOCOLS.


Documenta0onCompletedocumenta/onoflaserprocedureisrequiredinlaserlogandMeditech:

•  Laseroperator•  Pa/entinforma/on(name,RAandRM,birthdate)•  Typeoflaserused,manufacturerandserialnumber•  Laserfiber-size,manufacturer,referenceandlotnumbers,expira/ondate

•  Surgeon•  Surgicalprocedure•  Laserse_ngsandparameters•  Safetymeasuresimplementedduringcase•  Pa/entprotec/on



Laseruseinsurgerycanposeseriousriskstobothpa0entsandstaff.Understanding:

•  howtheywork•  safetymeasuresthatneedtobefollowed•  yourimportantroleinthelasersafetyprogram

willleadtoasuccessfuloutcomeforall!


References:Alexander’sCareofthePa0entinSurgery14thed.,editedby

JaneRothrock;associateeditor,DonnaMcEwen.(Missouri,ElsevierMosby,2011),pp.226-241.

RecommendedPrac0cesforLaserSafetyinPeriopera0vePrac0ceSeWngs.In:Periopera0veStandardsandRecommendedPrac0ces.AORN,eds.2010ed.(Colorado,AORN)

LaserSafetyinSurgicalServices.Kris/nVarnesRN,MSN,CNOROSHATechnicalManual,Sec0onIII,Chapter6.LaserHazardswww.osha.gov.