Laser Physics and Safety in Surgery Protecting our patients Protecting others Protecting ourselves Cindy Caton RN, BSN Interim Clinical Educator, Perioperative Services February 2012
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
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Lightisaformofelectromagne/cenergythatcanbeillustratedonacon/nuumknownastheelectromagne/cspectrum.
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Characteris0csofLaserlight
Monochroma0c-lightiscomposedofphotonsofthesamewavelengthorcolor.Incontrast,ordinarylightconsistsofmanydifferentcolorsorwavelengths.Collimated-consistsofwavesparalleltoeachother,whichallowslighttobefocusedintoa/nyspotthathighlyconcentratestheenergy.Coherent-allthewavesareorderlyandtravelinthesamedirec/on,givinglaserbeampower.
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TissueInterac0onWhenlaserenergyisdeliveredtoatargetsite,fourdifferentinterac/onscanoccur:Reflec0on-thedirec/onofthebeamischangedaJeritcontactsanarea.Sca9ering-beamspreadsoveralargeareaas/ssuecausesthebeamtodisperse.Transmission-beampassesthroughfluidsor/ssuewithoutthermallyaffec/ngthearea.Absorp0on-/ssueisalteredfromtheabsorp/onofthebeam.
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Fivemajorcomponentsoflasersystem:Laserhead-componentinwhichlaserenergyisgeneratedandamplified.Containstheac/vemediumthatgenerateslaserlight.Excita0onsource-suppliestheenergytoexcitetheac/vemediuminthelaserhead.Ancillarycomponents-otherlaserpartsneededtohelpproducelaserenergy(i.e.coolingsystem)Controlpanel-regulatesdeliveryoflaserenergyDeliverysystem-devicethatconductslaserenergyfromthelaserheadtotargetsource.
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AncillaryComponents
ControlPanel
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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
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Commonlyusedlasersinsurgery:CO2-• Usesapremixedgasofcarbondioxide,heliumandnitrogenastheac/vemedium.
• Highlyabsorbedbywater• Thedegreeof/ssueresponseisrelatedtotheamountofheatbuildupfromabsorp/onofCO2beam
• Beamisdeliveredtotargetsitethroughanar/culatedarmorlaserfiber
• CommonlyusedinENTandGYNprocedures
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Holmium:YAG-• Crystalisthelasersource• Highlyabsorbedbywater• Canbeconductedtotarget/ssuethroughaflexiblefiber
• Producesavaporbubblethattransmitslaserenergywithinashortdistance
• Commonlyusedinurology
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Argon-• Visiblelaserbeamwithblue-greenlight• Highlyabsorbedbypigmented/ssue• Laserenergyisconvertedtoheat,causingcoagula/onorvaporiza/on
• Deliveredtotargetsitethroughfiberorslit-lamp
• CommonlyusedinENTandOphthalmology
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KTP-• Beamiscolorselec/veandhighlyabsorbedbyhemoglobinandmelanin
• Producesanintensegreenlaserlight• Wavelengthcanbethroughclearsolu/onsandstructures
• Beamisconductedto/ssuethroughafiber• CommonlyusedinNeurootology
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Diode(980)-• CommonlyusedintreatmentofBPH• Laserenergycanbedelivereddirectlyto/ssuethroughafiber
• Highlyabsorbedinbothwaterandhemoglobin
• Providesanearbloodlessprocedurethroughbothcu_ngandcoagula/onof/ssue
Lasersystemsarecapableofconcentra0nghighamountsofenergywithinverysmall
areas,whichcanpresenthazards.Healthcarefacili0esarerequiredtohaveacomprehensivelasersafetyprogramin
place.
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Thelasersafetyprogramincludes:1.Iden/fica/onoflaserhazardsandcontrolmeasures2.Annuallasersafetyeduca/onandcompetencytes/ngofassociates3.Managementandrepor/ngofaccidentsorincidentsrelatedtolaserprocedures4.Laserserviceandpreven/vemaintenance
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ALLLASERSMUSTBETESTEDANDAPPROVEDBYBIOMEDPRIORTOUSEIN
SURGERY.
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Generalsafetyprecau0onsEyeprotec0on-• Theeyeisextremelysensi/vetolaserradia/onandmustbeadequatelyprotectedduringlasersurgery.
• Everyoneinnominalhazardzonemustwearprotec/veeyewearorusefiltersofspecificwavelengthandop/caldensityforlaseruse
• Pa/entsmustbeappropriatelyprotected(gogglesorglasses,moistenedeyepads,eyeshields)dependingontypeoflaserused
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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
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LaserProcedureguidelines:
Circulatorroles: • Knowledgeableofprecau/onsforeach
par/cularlaser• Dispensessterilewaterorsalinetoopera/vefield
• Flammableprepsarenottobeused• Ensurespa/entsafetythroughoutprocedure• Documentsdetailsregardinglaseruseinmeditech
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Scrubroles: • Knowledgeableofprecau/onsforeach
par/cularlaser• Sterilewaterorsalineshouldbereadilyavailableonthefield
• Spongesortowelsnearthetargetsiteshouldbekeptwet
• Instrumentsusedinthevicinityoflasertreatmentshouldbenonreflec/ve
• Thewhereaboutsofthelaserismonitoredatall/mes
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AnesthesiaandLasers: • PVCEndotrachealtubes(ETTs)arehighlyflammable,
especiallywhenusingO2duringanesthesiaadministra/on
• Laser-retardantETTsshouldbeusedduringoral,trachealoresophageallaserprocedures
• ETTsshouldbeinflatedwith/ntedsaline• Nonexplosivegasesshouldbeusedduringlaseprocedures
• Incaseofendotrachealfire:– Stopven/la/on,disconnectgasflow– Ex/nguishallflameswithsaline– RemoveETT– Ven/latepa/entbymaskorreintubate– Examinetheairwayforburnsorforeignbodies
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Firesafetyprotocols:• Ensuresterilewaterorsalineisimmediatelyavailableonthefieldtodousesmallfire
• Knowloca/onofandhowtooperatelaser-appropriatefireex/nguisher
• Usewettowels,nonflammabledrapesnearthelasertargetarea
• Donotuseflammablematerialsnearthelaserimpactsite
• Allowflammableskinprepstothoroughlydry• Onlyac/vatethelaserwhenthedelivery/piswithintheuser’sdirectfieldofvision
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IMPORTANTKEENAWARENESSTOTHESURGICALFIELDISKEYINPREVENTINGALASERINDUCEDPROCEDURALFIRE.
USECURRENTFIRESAFETYPROTOCOLS.
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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
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Laseruseinsurgerycanposeseriousriskstobothpa0entsandstaff.Understanding:
• howtheywork• safetymeasuresthatneedtobefollowed• yourimportantroleinthelasersafetyprogram
willleadtoasuccessfuloutcomeforall!
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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.