AORN Journal
Volume 87, Issue 4 , Pages 721-738 , April 2008

The Hazards of Surgical Smoke

  • Brenda C. Ulmer, RN, MN, CNOR

      Affiliations

    • Brenda C. Ulmer, RN, MN, CNOR, is a senior clinical educator at Valleylab/Covidien, Boulder, CO. As an employee of Valleylab/Covidien, Ms Ulmer has declared she has an affiliation that could be perceived as posing a potential conflict of interest in publishing this article.

References 

  1. Ott DE . Smoke and particulate hazards during laparoscopy procedures . Surg Serv Manag . 1997;3(3):11–13
  2. Ball K, Dennis V. Workplace safety. Presented at: The 54th AORN Congress; March 11–15, 2007; Orlando, FL.
  3. Mihashi S, Ueda S, Hirano M, Tomita Y, Hirohata T. Some problems about condensates induced by CO2 laser irradiation. Paper presented at: Fourth International Society for Laser Surgery; November 1981; Tokyo, Japan.
  4. Andersen E . Surgical smoke—is there a fire? . AAOHN J . 2005;53(3):103–104
  5. Giordano BP . Don't be a victim of surgical smoke [Editorial] . AORN J . 1996;63(3):520–522
  6. Control of smoke from laser/electric surgical procedures. NIOSH Hazard Alertss, 1996. National Institute of Occupational Safety and Health . http://www.cdc.gov/niosh/hc11.html Accessed February 5, 2008.
  7. Romig CL , Smalley PJ . Regulation of surgical smoke plume [Health Policy Issues] . AORN J . 1997;65(4):824–828
  8. Ulmer BC . Occupational safety and health administration acts on guidelines for electrosurgical smoke [President's Message] . AORN J . 1998;67(6):1244–1245
  9. OSHA shelves plan to issue bulletin on surgical smoke . Hosp Empl Health . July 2000;78–80
  10. AORN position statement on workplace safety . In: Standards, Recommended Practices, and Guidelines . Denver, CO: AORN, Inc; 2004;p. 169–171
  11. AORN position statement on workplace safety . In: Standards, Recommended Practices, and Guidelines . Denver, CO: AORN, Inc; 2007;p. 416–417
  12. Wu MP , Ou CS , Chen S , Yen EY , Rowbotham R . Complications and recommended practices for electrosurgery in laparoscopy . Am J Surg . 2000;179(1):67–73
  13. Massarweh NN , Cosgriff N , Slakey DP . Electrosurgery: history, principles, and current and future uses . J Am Coll Surg . 2006;202(3):520–530
  14. Youker SR , Ammirati CT . Practical aspects of laser safety . Facial Plast Surg . 2001;17(3):155–163
  15. Anderson K . Safe use of lasers in the operating room—what perioperative nurses should know . AORN J . 2004;79(1):171–188
  16. ECRI  . Surgical smoke evacuation systems . Operat Rm Risk Manage . 2000;7(2):1–7
  17. Siperstein AE , Berber E , Morkoyun E . The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery . Arch Surg . 2002;137(2):137–142
  18. Barrett WL , Garber SM . Surgical smoke—a review of the literature . Bus Brief: Glob Surg . 2004;1–7
  19. Heinsohn P , Jewett DL . Exposure to blood-containing aerosols in the operating room: a preliminary study . Am Ind Hyg Assoc J . 1993;54(8):446–453
  20. Pillinger SH , Delbridge L , Lewis DR . Randomized clinical trial of suction versus standard clearance of the diathermy plume . Br J Surg . 2003;90(9):1068–1071
  21. Yeh HC , Turner RS , Jones RK , Muggenburn BA , Lundgren DL , Smith JP . Characterization of aerosols produced during surgical procedures in hospitals . Aerosol Sci Tec . 1995;26(3):511–518
  22. González-Bayón L , González-Moreno S , Ortega-Peréz G . Safety considerations for operating room personnel during hyperthermic intraoperative intraperitoneal chemotherapy perfusion . Eur J Surg Oncol . 2006;32(6):619–624
  23. Karoo RO , Whitaker IS , Offer G , Sharpe DT . Surgical smoke without fire: the risks to the plastic surgeon . Plast Reconstr Surg . 2004;114(6):1658–1660
  24. Taravella MJ , Viego J , Luiszer F , et al.   Respirable particles in the excimer laser plume . J Cataract Refract Surg . 2001;27(4):604–607
  25. Dykes CN . Is it safe to allow smoke in our operating room? . Today's Surg Nurse . 1999;21(2):15–21 38–39.
  26. Ulmer BC . Air quality in the operating room . Surg Serv Manage . 1997;3(3):18–21
  27. Plappert UG , Stocker B , Helbig R , Fliedner TM , Seidel HJ . Laser pyrolysis products—genotoxic, clastogenic and mutagenic effects of the particulate aerosol fractions . Mutat Res . 1999;441(1):29–41
  28. Pyrolysis . In: Webster's College Dictionary . New York, NY: Random House; 2001;p. 1078
  29. Capizzi PJ , Clay RP , Battey MJ . Microbiologic activity in laser resurfacing plume and debris . Lasers Surg Med . 1998;23(3):172–174
  30. Garden JM , O'Banion K , Bakus AD , Olson C . Viral disease transmitted by laser-generated plume (aerosol) . Arch Dermatol . 2002;138(10):1303–1307
  31. Baggish MS , Baltoyannis P , Sze E . Protection of the rat lung from the harmful effects of laser smoke . Lasers Surg Med . 1988;8(3):248–253
  32. Hollmann R , Hort CE , Kammer E , Naegele M , Sigrist MW , Meuli-Simmen C . Smoke in the operating theater: an unregarded source of danger . Plast Reconstr Surg . 2004;114(2):458–463
  33. Brandon HJ , Young LV . Characterization and removal of electrosurgical smoke . Surg Serv Manage . 1997;3(3):14–16
  34. Nicola JH , Nicola EM , Vieira R , Braile DM , Tanabe MM , Baldin DH . Speed of particles ejected from animal skin by CO2 laser pulses, measured by laser Doppler velocimetry . Phys Med Biol . 2002;47(5):847–856
  35. Tanpowpong K , Koytong W . Suspended particulate matter in an office and laser smoke particles in an operating room . J Med Assoc Thai . 2002;85(1):53–57
  36. Alp E , Bijl D , Bleichrodt RP , Hansson A , Voss A . Surgical smoke and infection control . J Hosp Infect . 2006;62(1):1–5
  37. Gatti JE , Bryant CJ , Noone RB , Murphy JB . The mutagenicity of electrocautery smoke . Plast Reconstr Surg . 1992;89(5):781–784
  38. Wenig BL , Stenson KM , Wenig BM , Tracey D . Effects of plume produced by the Nd:YAG laser and electrocautery on the respiratory system . Lasers Surg Med . 1993;13(2):242–245
  39. Fletcher JN , Mew D , DesCoteaux JG . Dissemination of melanoma cells within electrocautery plume . Am J Surg . 1999;178(1):57–59
  40. Moot AR , Ledingham KM , Wilson PF , et al.   Composition of volatile organic compounds in diathermy plume as detected by selected ion flow tube mass spectrometry . ANZ J Surg . 2007;77(1–2):20–23
  41. Beebe SS , Swica H , Carlson N , Palahniuk RJ , Goodale RL . High levels of carbon monoxide are produced by electrocautery of tissue during laparoscopic cholecystectomy . Anesth Analg . 1993;77(2):338–341
  42. Dawes BG . Stop smoke campaign begins with you [Editorial] . AORN J . 2000;72(5):768–770
  43. Kunachak S , Sobhon P . The potential alveolar hazard of carbon dioxide laser-induced smoke . J Med Assoc Thai . 1998;81(4):278–282
  44. Ball K . Update for nurse anesthetists. Part I. The hazards of surgical smoke . AANA J . 2001;69(2):125–132
  45. Stationary surgical smoke evacuation systems . Health Devices . 2001;30(3):73–86
  46. Weld KJ , Dryer S , Ames CD , et al.   Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility . J Endourol . 2007;21(3):347–351
  47. In: Surgical Smoke: What We Know Today . Boulder, CO: Valleylab; 1998;p. 11
  48. Wilburn S . Is the air in your hospital making you sick? . Nurs World . July 2006; http://www.nursingworld.org/ajn/1999/july/heal079b.htm Accessed February 3, 2008.
  49. Recommended practices for electrosurgery . In: Standards, Recommended Practices, and Guidelines . Denver, CO: AORN, Inc; 1994;p. 141–148
  50. Recommended practices for laser safety in the practice setting . In: Standards, Recommended Practices, and Guidelines . Denver, CO: AORN, Inc; 1994;p. 191–196
  51. Recommended practices for electrosurgery . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 315–329
  52. Recommended practices for laser safety in practice settings . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 447–452
  53. Recommended practices for a safe environment of care . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 351–373
  54. AORN  . OSHA collaborate on workplace safety issues . AORN Connections . 2007;5(1):5
  55. Z136.3 American National Standard for Safe Use of Lasers in Health Care Facilities . Orlando, FL: Laser Institute of America; 2005;
  56. OSHA aligns with the Joint Commission on Accreditation of Healthcare Organizations and Joint Commission Resources, Inc [news release] . Oakbrook Terrace, IL: the Joint Commission on Accreditation of Healthcare Organizations and Joint Commission Resources; August 2, 2004;
  57. Stanton C . OSHA alliance provides new resources for perioperative workplace safety issues . AORN Connections . 2007;5(7):8–9 14.
  58. Paschall V . Smoke vs the people: setting up a smoke safe environment . Surg Serv Manage . 1997;3(3):27–30

  indicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article and taking the examination on pages 735–736 and then completing the answer sheet and learner evaluation on pages 737–738.You also may access this article online at http://www.aornjournal.org.The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as potential conflicts of interest in publishing this article.This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.

PII: S0001-2092(07)00693-X

doi: 10.1016/j.aorn.2007.10.012

AORN Journal
Volume 87, Issue 4 , Pages 721-738 , April 2008

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