1. Laser Safety
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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
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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
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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
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Laser Safety

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