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April 25, 2024
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HEALTH HAZARD Surgical smoke is hazardous, whether it's visible or invisible, odoriferous or odorless.If you can't see it and you can't always smell it, then it must not exist. That's often the attitude toward electrosurgical smoke. But smoke from electrosurgical devices does exist and research shows it can be as dangerous as any laser plume you can see, smell and measure.
Many of our nurses are certified through AORN and participate in organization activities, closely watching new guidelines and standards. Smoke evacuation in the OR is a basic AORN principle.
When it came to laser smoke, because you could see and smell the particulates, it was an easy sell to convince staff and surgeons of the dangers. We adopted and embraced smoke evacuation early on.
But when electrosurgery became more prevalent, that was a different matter; it wasn't recognized that this surgical method produces smoke just like laser surgery. With electrosurgery, you may not see the plume because it is so finite, and you can't always smell the particulates. But just as in laser surgery, these particulates contain blood, dead and living material, potentially infectious viruses and bacteria, as well as potentially hazardous chemicals such as acrolein, benzene, formaldehyde, toluene and polycyclic aromatic hydrocarbons. Research has shown contaminants have carcinogenic potential.
Making the case
Any new technology will come up against resistance unless you can show data to prove it's necessary. All staff needed persuading, but our RNs led the initiative. It can take 20 minutes for OR ventilation to return a room to baseline levels, and we RNs are the ones who set up the ORs.
In addition to the literature, AORN materials are a major source of information (access AORN's "Management of Surgical Smoke Tool Kit" here: tinyurl.com/amtyg4d). Through research we learned about the hazards of surgical smoke, whether it's visible or invisible, odoriferous or odorless. Understanding particle size is essential, because each technology produces different-size particles, ranging from 0.1 to 5.0 micrometers. Particles that are 5.0 micrometers or larger are deposited in the upper airway; particles smaller than 2.0 micrometers can infiltrate the bronchioles and alveoli.
We became convinced that an electrosurgical pen with attached smoke evacuator system — new to the market at that time and supplied by a vendor we have a strong history with — was the best option for our center because the 2 functions were integrated into a single device. The system evacuates the smoke from the pencil while it's cauterizing. A cost analysis estimated an additional $4 per patient expenditure, whether the device was attached to the ESU pencil as an in-line filter on laparoscopic procedures or whether it was extracting laser plume from the external surgical site.
5 NEW PRODUCTS
The Latest Smoke Evacuators
Thumbnail sketches of 5 newer smoke evacuation devices.
— Compiled by Lauren Roberts
Plume Pen
Buffalo Filter
buffalofilter.com
• Smoke plume evacuation at the surgical site. The sleek, compact design offers free range of motion and accommodates the surgeon's blade preference, which not all surgical smoke plume pencils do. PlumePen features a 360 ? swivel, allowing for more comfort and less tension on the wrist. The ESU wire in the smoke evacuation tube also provides cord management. The tube above the blade is transparent, which tracks smoke as it rises.
PlumePort ActiV
Buffalo Filter
buffalofilter.com
• Designed for laparoscopic plume evacuation. As plume begins to build within the peritoneal cavity, visibility concerns add to the safety hazards associated with the plume. The PlumePort ActiV, with integrated ULPA filtration and moisture management, removes and filters peritoneal plume during laparoscopic procedures. It's silent, connects easily to standard trocars and actively draws plume out of the peritoneal cavity, allowing for a clearer field of vision. A wicking system ensures the filter doesn't become saturated and the flow remains continuous. The device acts as a universal connection to standard Luer-lock fittings, such suction systems as Neptune's or Dornoch's, and canisters or wall suction systems.
Smoke Shark II
Bovie Medical
boviemedical.com
• The newest release from Bovie. The Smoke Shark II offers a compact, modern design and cost-effective filter. The lightweight (10 lbs.) system minimizes exposure to smoke plume for up to 35 hours, reducing procedure costs by 38% when operated at the lowest setting. It also operates with the optional Bovie Remote Activation Switch (SERS2) to increase filter duration and surgical accuracy. Low-, medium- and high-flow settings are available, with technology gauging the flow setting and adjusting the filter accordingly. The Smoke Shark II is extremely quiet, especially when compared to the previous model.
Ultra Vac Smoke Evacuation Pencil
Megadyne
megadyne.com
• Quiet and powerful pencil. The Ultra Vac Smoke Evacuation Pencil now comes with cord-in tubing, allowing for a swivel elbow and more range of motion for surgeons. You can adjust the telescopic nose up to 6 inches, enabling more concise smoke evacuation while the tip is closer to the surgical site. The Venturi-effect nose cone design increases the velocity of airflow, much like a tornado, drawing smoke away from the surgical site without clouding the surgeon's field of vision. There's no need to change tips with the easily cleaned electrosurgical tip.
miniSQUAIR
Nascent Surgical
nascentsurgical.com
• Hexagon-shaped miniSQUAIR. Unlike its earlier counterpart, SQUAIR, the miniSQUAIR is a less bulky hexagon shape, as opposed to a 14x14 square. Easy to use and quick to apply, it can adhere to both skin and surgical drapes, and doesn't require the use of team members during surgery. Remove the adhesive backing and affix the device adjacent to the incision line, and then attach the tubing to a suction device with adjustable settings. The low profile doesn't obstruct surgeons' views.
We presented our findings to our medical advisory board: This is the latest research on the hazards of smoke; this is the newest technology; this is why we like it; this is what it would cost per patient, and what it would contribute to patient and staff safety, including surgeons. The board agreed it was a necessity.
When we brought in the technology, we discovered that, as with anything new, it requires some adjustment to use. The suction was loud — all evacuation systems create some additional noise — and has a different feel in surgeons' hands. Now, instead of a skinny cord on the pencil, there's a suction tube that's a bit larger than the old cord. Surgeons have to get comfortable with the bulkier feel.
Every so often, because of these inconveniences, a physician is reluctant to use the evacuation technology. Staff might then turn down the volume on the device or decrease the suction level so it's less noisy. Through education, staff makes it transparent that it's important to always capture the particulate from any source, whether electrosurgical, laser, drill, external or internal.
PRACTICAL PEARLS
8 Steps to Compliance
TOTAL COMPLIANCE Find out how to convince your surgeons and staff of the importance of smoke evacuation.Convincing your surgeons and staff of the importance of smoke evacuation is not a once-and-done task. It takes vigilance, education and patience to achieve 100% compliance. To make the case for adopting smoke evacuation technology, try these tips:
- Acknowledge the problem.
- Research the data.
- Refer to AORN guidelines — we use them as our bible, our gold standard for how to operate safely.
- Analyze your options; a cost-benefit analysis including cost per patient will support your data.
- Present the data to everyone involved — all staff should know the facts.
- Prepare for resistance and respond to it with the facts.
- Be persistent; present the evidence patiently. Persistence always wears down resistance and repetition is a good way to teach.
- Expect this to be an ongoing education process to achieve 100% compliance.
— Lizbeth Bozeman, RN, CNOR
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