Laser Safety 0107 Laser Safety

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fire Prevention Airway Non-combustible endotrachael tubes 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 Rarely used in pediatric airway cases Illustrates how a laser can damage a metal wrapped ET tube Laser Safety

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

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

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

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

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

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

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

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

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

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