Minimizing Fuel Sources
Now let’s take a look at fuel sources and how they can be controlled. The surgical team needs to be aware of what materials are flammable and combustible. Typical fuel sources involve some form of combustible or flammable material, which will be consistent from facility to facility. They include but are not limited to: skin preparations, bone adhesives, aerosols, ointments, drapes, scrubs, gowns, mattress pads, plastic bag, suction canisters, tubing, sponges, tapes, dressings, gloves, suture supplies, wiring and airway maintenance devices. The patient is also a potential fuel source because of body hair, fatty tissue, and gastrointestinal gases (hydrogen, methane). Staff must understand that any material or element with a carbon base can be ignited and will burn. This is especially true in any setting with an oxygen-enriched atmosphere.
o Before any surgery commences, the surgical team should assess the flammability and combustibility of the materials that are going to be used in surgery.
o Use only flame or fire resistant drapes. Metallic foil and polypropylene laser-retardant and ignition-resistant drapes are available. Drapes are typically hung vertically from the surgical field towards the floor. This vertical alignment allows a fire to propagate across the surface of the drape and should be avoided, when possible. Because the drapes are fire retardant, a small fire can develop underneath the drapes and obscure visible flames, smoke and heat. Avoid tenting of surgical drapes, as this process can allow the build-up of oxygen or flammable vapors underneath the drape. If possible, use open drapes that allow gases and vapors to escape, unless there is a need to completely seal off the patient’s surgical field.
o Alcohol and tinctures are highly flammable and volatile. Flammable liquids and vapors must not be allowed to accumulate under drapes because they can readily ignite. Don’t permit staff to allow open containers of flammable liquids anywhere in the surgical area; any open container should be closed immediately. Prevent the potential pooling of flammable skin prep solutions by checking around the prepped area and underneath the patient. If some of the solution is visible, soak up the solution following its application. Don’t place drapes over the patient until the solution has dried fully. A “surgical time-out” is sometimes used to allow sufficient drying time. Some healthcare facilities require a ten-minute minimum drying time. Remember that the material used to soak up the solution may also be very flammable. The material should be removed to a safe area away from the surgical field and patient.
o When using any new skin preparation, adhesive, aerosol, or ointment for the first time, a Material Safety Data Sheet (MSDS) should be obtained to determine the flammable characteristics and safe handling procedures of the material prior to use. In all circumstances, the least flammable or reactive material should be used by staff.
o Anytime a fiberoptic light source is going to be used, it should be secured away from the ends of any drape. Don’t attempt to plug or unplug cable connections together with the power supply on. Turn-off any fiberoptic light source when not in use.
o Develop guidelines for patients that address hair care products, facial care products, and make-up. Many times these products can add to the fuel load. Coat any facial hair near the surgical site with a water soluble surgical jelly to eliminate a potential fuel source.
o Use surgical materials and items that are designed not to reflect laser light. Use only laser-resistant endotracheal tubes during upper airway surgery.
o Moisten sponges, gauze, and other items that are to be used in or near the surgical site with saline or sterile water to lessen the chance of ignition. Consider using towels soaked in the same manner.
o Consider using a slow-drip of saline solution on the moving part of the drill or burr to reduce the amount of heat that is built-up. Never place a recently used drill, bur, or saw blade in close proximity to the patient.
o During any bowel or rectal surgery, the surgical team should remember that intestinal gases can be highly flammable. Never cut or open a bowel with an ESU or laser. Suction may be used to remove some of the intestinal gases.
Page 5 