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Laser Safety 0107 Laser Safety.

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Presentation on theme: "Laser Safety 0107 Laser Safety."— Presentation transcript:

1 Laser Safety 0107 Laser Safety

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

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

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

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

6 Eye Safety Unprotected eyes can become injured in two places Cornea
Retina Safety Alert: All safety eyewear must be wavelength specific for each laser regardless of color. Staff member with corneal injury from not wearing laser safety glasses Cornea 0107 Retina Laser Safety

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

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

9 Eye Safety 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. Laser Safety

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

11 Eye Safety 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. Laser Safety

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

13 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. Laser Safety

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

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

16 Plume 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 All staff should wear PPEs, including special high filtering laser masks Laser Safety

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

18 Fire Prevention Airway Non-combustible endotrachael tubes Laser Safety

19 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 Rarely used in pediatric airway cases Illustrates how a laser can damage a metal wrapped ET tube Laser Safety

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

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

22 Nursing Considerations for Fire Prevention
Always use non-flammable prep agents 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 Laser Safety

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

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

25 Anesthesia Considerations
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. Connects to O2 wall port Gage to measure pressure 010 Laser Safety Delivery device

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

27 Safety Considerations
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 Check all electrical components of laser before plugging unit into wall. STANDBY Please… …the laser is in STANDBY, Doctor Laser Safety

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

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

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