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Vol. 5, No. 2 May 1997 |
Surgical Smoke Plume
What is Plume?
Surgical smoke plume occurs when the thermal destruction of tissue or bone is achieved by laser, electrosurgery units (ESU) or other surgical power instruments. The released smoke plume consists of carbonized tissue, blood, viral particles, DNA, bacteria, water, carbon dioxide and toxic gases. These airborne particles are small enough to penetrate deep within the respiratory tract.
Historical Development
1970s:
- Surgeons and OR staff regarded smoke plume as a foul smelling nuisance that occasionally obstructed the surgeon's visual field, creating delays to clear vision.
1980s - Research discovered:
- Plume ranged from 0.1 to 0.8 microns which is too small to be effectively filtered by a standard surgical mask.
- Exposure to laser plume caused pathological changes to the lungs of rats.
- Intact DNA from human papilloma virus (HPV) vaporized by a CO2 laser could be liberated into the air.
1990s - Research discovered:
- Presence of abdominal smoke during laparoscopic procedures caused a dramatic increase in methaemoglobin levels of patients resulting in reduced oxygen-carrying capacity of the blood.
- The presence of HIV DNA in laser smoke was detected in culture on the 14th day and non-viable by the 28th day.
Recent Actions
1996:
- The first surgical smoke conference at AORN Headquarters.
- The National Institution for Occupational Safety and Health (NIOSH) issued a hazard control statement that calls for evacuation of smoke generated by lasers and ESUs.
Guidelines
- Smoke evacuators should be considered whenever tissue is vaporized.
- The evacuator should be able to appropriately filter smoke plume particles and also contain an activated charcoal filter to remove odors.
- The appropriate evacuator system is selected for the amount of smoke generated, that is from the very light smoke generating procedures, e.g. Laparoscopic through to heavy smoke generating procedures, e.g. mastectomy.
- The evacuator inlet nozzle is held at the appropriate distance from the surgical site to capture the smoke plume.
- Follow manufacturers recommendations on use of each unit.
- On procedure completion, all disposable components are treated as biohazardous material.
Additional research is needed to further develop these guidelines into working recommendations. At present, education and increased awareness are the most effective instruments for change.
References
- Winstin C. The Effects of Smoke Plume Generated During Laser and Electrosurgical Procedures. Minimally Invasive Surgical Nursing 1994;8:3
- O'Grady KF, Easty A.C. Electrosurgery Smoke: Hazards and Protection. Journal of Clinical Engineering 1996; 21:3.
- Roming CL, Smalley PJ. Regulation of Surgical Smoke Plume. AORN Journal 1997;65:4.
Web Sites
- http://www.cdc.gov/ niosh.hcll.html or call 1-800-35NIOSH (1-800-356-4674)
- http://www.aorn.org/ NSGTODAY/HOT/smoke.htm
Guest Editor: Diane Weinwurm, CIC, ICP
Doctor's Hospital
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