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0107Laser Safety. 0107Laser Safety Laser Safety Objectives Describe basic safety using lasers in the operating room. Describe basic safety using lasers.

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Presentation on theme: "0107Laser Safety. 0107Laser Safety Laser Safety Objectives Describe basic safety using lasers in the operating room. Describe basic safety using lasers."— Presentation transcript:

1 0107Laser Safety

2 0107Laser Safety Laser Safety Objectives Describe basic safety using lasers in the operating room. Describe basic safety using lasers in the operating room. Explain steps to prevent eye injury during laser use. Explain steps to prevent eye injury during laser use. Determine when laser safety glasses are worn by OR personnel. Determine when laser safety glasses are worn by OR personnel. Describe how to prevent fire when using lasers Describe how to prevent fire when using lasers Classify three laser endotrachael tubes used at VUMC Classify three laser endotrachael tubes used at VUMC

3 0107Laser Safety Education is the Key to Safe Laser Use Surgeons complete: Didactic lecture on both laser and clinical applications. Didactic lecture on both laser and clinical applications. Hands-on experience with laboratory models. Hands-on experience with laboratory models. Preceptorship with experienced operators Preceptorship with experienced operators Residency training in University Hospitals Residency training in University Hospitals

4 0107Laser Safety Staff Education Support staff Didactic lecture on basic laser physics and laser safety Didactic lecture on basic laser physics and laser safety Operational training with return demonstration Operational training with return demonstration Candela Laser Holmium/YAG Laser CO2 Lasers YAG/KTP Laser

5 0107Laser Safety Injuries and Prevention Types of injuries to staff members Types of injuries to staff members Eye injuries Eye injuries Skin injuries Skin injuries Injury to patients Injury to patients Preventative measures Preventative measures

6 0107Laser Safety Eye Safety Unprotected eyes can become injured in two places Unprotected eyes can become injured in two places Cornea Cornea Retina Retina Cornea Retina 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.

7 Laser Safety Staff Safety Warning signs should be placed on all doors leading to the OR.

8 Laser Safety Staff Safety Always place eye protection on all doors leading into the operating room. Always place eye protection on all doors leading into the operating room.

9 Laser Safety Eye Safety For both open & closed procedures: appropriate eye protection is required for all viewers within the nominal hazard zone. For both open & closed procedures: appropriate eye protection is required for all viewers within the nominal hazard zone. The nominal hazard zone is considered to be the procedure room. The nominal hazard zone is considered to be the procedure room.

10 Laser Safety Patient Safety Patient Precautions for anesthetized C02 laser patient Patient Precautions for anesthetized C02 laser patient Eyes taped and lubricated Eyes taped and lubricated Saline saturated eye pads taped to face Saline saturated eye pads taped to face The awake patient may wear wavelength specific laser goggles. The awake patient may wear wavelength specific laser goggles.

11 Laser Safety Eye Safety Eyes may be protected with wavelength specific goggles (Argon, Dye, KTP, Nd:Yag) Eyes may be protected with wavelength specific goggles (Argon, Dye, KTP, Nd:Yag) Eyes may be shielded with saline soaked sponges covered by Aluminum foil if the wavelength specific goggles interfere with surgery. Eyes may be shielded with saline soaked sponges covered by Aluminum foil if the wavelength specific goggles interfere with surgery.

12 Laser Safety Prevention of Eye Injury CO2 laser Requires wavelength specific glasses or goggles with side guards Optics of operating microscope protects the surgeon

13 Laser Safety Prevention of Eye Injury All wavelength lasers: Require wavelength specific glasses/goggles with side guards Surgeon wears glasses or uses special filter lens on all scopes All wavelength Lasers require all viewing windows to be covered/closed except for the CO2.

14 Laser Safety Skin Injuries Laser light can be reflected off any shiny surface causing a variety of skin injuries. Laser light can be reflected off any shiny surface causing a variety of skin injuries.

15 Laser Safety Prevent Laser Light Reflection Use ebonized or dull finished instruments Use ebonized or dull finished instruments Modified laryngoscopes and bronchoscopes Modified laryngoscopes and bronchoscopes Special microlaryngeal instruments Special microlaryngeal instruments

16 Laser SafetyPlume Lasers produce plume (smoke) containing hazardous components which may cause eye, nose and throat irritation as well as nausea, vomiting, and flu-like symptoms. Lasers produce plume (smoke) containing hazardous components which may cause eye, nose and throat irritation as well as nausea, vomiting, and flu-like symptoms. HPV has been isolated in CO2 plume HPV has been isolated in CO2 plume All staff should wear PPEs, including special high filtering laser masks All staff should wear PPEs, including special high filtering laser masks

17 Laser Safety Adequate Plume (Smoke) Evacuation Double suction set-up Double suction set-up Place disposable filters in suction lines Place disposable filters in suction lines Use a separate smoke evacuator with disposable filter and tubing Use a separate smoke evacuator with disposable filter and tubing Filter

18 Laser Safety Fire Prevention Airway Airway Non-combustible endotrachael tubes Non-combustible endotrachael tubes

19 Laser Safety Laser Endotrachael Tubes These are examples of wrapped red rubber reusable endotracheal tubes which are rarely used due to problems with unwrapping during extubation. Tubes wrapped with metal tape to reflect laser light These are examples of wrapped red rubber reusable endotracheal tubes which are rarely used due to problems with unwrapping during extubation. Tubes wrapped with metal tape to reflect laser light Rarely used in pediatric airway cases Rarely used in pediatric airway cases Illustrates how a laser can damage a metal wrapped ET tube

20 Laser Safety Laser Endotrachael Tubes Xomed Lasershield-Adults Xomed Lasershield-Adults Use with CO2 and KTP airway cases Use with CO2 and KTP airway cases Cuff is inflated with methylene blue Cuff is inflated with methylene blue Cottonoids are packed around cuff Cottonoids are packed around cuff If cuff is hit with laser light, it punctures the cuff If cuff is hit with laser light, it punctures the cuff Methylene blue leaks onto cottonoids alerting staff of damaged cuff. Methylene blue leaks onto cottonoids alerting staff of damaged cuff. Cottonoids Methelene blue

21 Laser Safety Laser Endotrachael Lasertubus Endotrachael Tube-Adults Lasertubus Endotrachael Tube-Adults Used for airway procedures with the Nd:YAG laser Used for airway procedures with the Nd:YAG laser

22 Laser Safety Nursing Considerations for Fire Prevention Always use non-flammable prep agents Always use non-flammable prep agents Always keep a bowl/syringe of sterile saline/water on the back table to extinguish a fire Always keep a bowl/syringe of sterile saline/water on the back table to extinguish a fire Always use moist towels to drape surgical area for open procedures Always use moist towels to drape surgical area for open procedures

23 Laser Safety Nursing Considerations Always use moist sponges around the operative area when indicated Always use moist sponges around the operative area when indicated Keep the floor dry around the laser Keep the floor dry around the laser Avoid placing liquids on top of laser Avoid placing liquids on top of laser

24 Laser Safety Pre-procedure testing for Lasers Laser will be test fired (CO2) and/or calibrated prior to the patient entering the OR. Laser will be test fired (CO2) and/or calibrated prior to the patient entering the OR. If laser does not function properly If laser does not function properly Obtain another laser of the same wavelength Obtain another laser of the same wavelength Notify attending physician if no other laser is available Notify attending physician if no other laser is available

25 010Laser Safety Anesthesia Considerations Jet ventilation as an alternative to intubation. Jet ventilation as an alternative to intubation. To reduce risk of fire in cases involving the oral cavity, head or neck, a maximum gas mixture of 40% oxygen & 60% helium must be used. To reduce risk of fire in cases involving the oral cavity, head or neck, a maximum gas mixture of 40% oxygen & 60% helium must be used. Connects to O2 wall port Gage to measure pressure Delivery device

26 Laser Safety Airway Fire When ignition occurs When ignition occurs Disconnect oxygen supply Disconnect oxygen supply Flood area with water or saline Flood area with water or saline Immediately extubate the patient Immediately extubate the patient Secure a new airway Secure a new airway Oral airway Oral airway Reintubate with smaller cuffed or uncuffed ET tube Reintubate with smaller cuffed or uncuffed ET tube

27 Laser Safety Safety Considerations Surgeon directing the laser energy, should be in control of the foot pedal. Surgeon directing the laser energy, should be in control of the foot pedal. Place laser on stand-by each time the surgeon takes his/her foot off the foot pedal Place laser on stand-by each time the surgeon takes his/her foot off the foot pedal Check all electrical components of laser before plugging unit into wall. Check all electrical components of laser before plugging unit into wall. STANDBY Please… …the laser is in STANDBY, Doctor

28 Laser Safety Laser Documentation Document which laser is used Document which laser is used Safety measures are taken Safety measures are taken Time laser is used Time laser is used Document in OR nursing record and Laser Log if unit requires Document in OR nursing record and Laser Log if unit requires

29 Laser Safety Troubleshooting Guide 1. Check power source 2. Check all connections 3. Turn laser off and back on 4. Call charge nurse of the service line 5. Call Unit Laser Safety Officer


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