Question

Daniela is a CST working the day shift. She is scheduled to be the first scrub on a procedure in which a laser will be used to obliterate abnormal tissue in the larynx and is preparing the room. What policies and procedures should be in place to ensure the patient's safety? What are the possible concerns regarding the anesthetic used in this case? What specific safety issues should Daniela consider in preparing for this case?

Answer 1

Policies and procedures should be placed to make sure patients safety practice that should include laser sanitation, safety audit, event reporting, documentation, handling of laser system, equipment check before procedure, preventive maintenance schedule, list of authorized laser users and team members, reporting and impounding damaged equipment, laser from access with proper signals, fire prevention and response, fire management, training for laser users and team members, preventing electrical hazards. policy and procedures every two years updated by the laser safety officer and safety committee, written standards, operating procedures, laser PPE and protecting precautions to protect the patient eye from injury from laser beam exposures.
Anesthetist mask should be in the plastic/rubber products. In anesthesia procedure ET tube cuff rupture during the procedure there will be blue dye on the plague that alerts the team. if airway fire suspected team should take action due to hot gas can damage the patient lungs and cause life-threatening by causing lung tissue injuries. The anesthesia provider should turn off the gases immediately after removing the ET tube. should not use flammable or burning materials from the airway. provide clamp to the surgeon to remove sponges around the ET tube. anesthesia providers can reestablish ventilation by the mask. CST needs to request and setup bronchoscopy, anesthesia provider and surgeon should assess patient status whether the procedure to be continued or not. airway fire materials and the device should be labeled and bag.
CST should be responsible for correct sterile laser instruments for the procedure that will be used by the surgeon that should avoid unintended laser beam reflection, ensuring breakage and scratches in the surface coating from the sterile pack table. the defective instruments should be removed and send for disposable or for repair. Do not etch the coating surface that causes laser reflection. CST assists with the surgeon and monitors the position to avoid reflection. If the surgeon uses hot-ebonized instrument CST should wrap saline around the instrument to prevent laser fire and laser reflection. CST should have titanium rods for backstops during co2 laser surgery to avoid non-targeted tissue damage.