Aim
To highlight the use of a diathermy device in the presence of concentrated oxygen creates a high risk of surgical fires. Theatre teams must be alert to this risk and implement risk mitigation strategies prior to commencing surgery.
Background
Fires have occurred in the operative field that have almost instantly spread to include drapes and oxygen masks and tubing. Patients have sustained serious burns to the face and hands.
High risk procedures involve a combination of:
- An open oxygen source such as mask or nasal prongs
- Surgery of the head and neck involving the use monopolar diathermy that creates a spark. Lasers also have ignition potential.
- Availability of a fuel such as particles of biological material, skin and hair, alcoholic skin prep, PVC mask and tubing, and drapes and blankets.
Safety checklist
- Discuss fire risk mitigation as part of the Time Out check prior to high-risk procedures.
- Avoid open supplemental oxygen if not required or, if continuous supplementation is required, limit delivery to 2l/min through properly placed nasal cannula or convert to a closed system with general anaesthesia.
- Use aqueous-based antiseptics only.
- Use open face draping taking care to prevent oxygen pooling, as well as flame-resistant surgical drapes if available.
- Stop open oxygen 60 seconds before using electrocautery.
- Use an electrocautery device, preferably bipolar diathermy, less than 15 W, with a clean tip at least 5 cm from the oxygen source.
- Use a sucker adjacent to the diathermy to remove vapour and reduce local oxygen concentration.
- Moisten all swabs and sponges before use.
- Have one litre of sterile water accessible inside the sterile field, and a carbon dioxide fire extinguisher outside the operating theatre, ensuring all staff are trained to use it.
- Do not use paraffin or other flammable agents around the operative site.
References
Teresa S. Jones, M.D., Ian H. Black, M.D., Thomas N. Robinson, M.D., Edward L. Jones, M.D. Operating Room Fires. Anesthesiology. 2019; 130:492–501
Alani H, Southwell-Keely J, Moisidis E, Haddad R, Clarke F, Kernohan M. Prevention of surgical fires in facial plastic surgery. Aust J Plast Surg. 2019;2(2):40–49.