Although rare, surgical fires can have serious consequences. There are three elements required to start a fire: fuel, an ignition source, and a source of oxygen. Because the OR is an oxygen-enriched atmosphere (OEA), fire prevention is the responsibility of the entire OR team. Below is a brief discussion of some fire safety precautions. Further information can be obtained from the Association of periOperative Registered Nurses' Position Statement on Fire Prevention available at http://www.aorn.org.
Anesthesia considerations
* Use the lowest O2 concentrations possible.
* Be aware of OEA near the surgical site, especially in head and neck procedures.
* Stop O2 at least 1 minute before the use of any heat source.
* Minimize the buildup of O2 and N2O beneath drapes.
* Turn off O2 between cases.
OEA considerations
* Use moist packing around uncuffed endotracheal (ET) tubes.
* Use water-soluble instead of oil-based lubricants.
* Avoid the use of an electrosurgical unit (ESU) to enter the airway during tracheotomies.
Fire prevention
* Keep a bowl of sterile water or saline on the back table.
* Keep laps and sponges moist.
* Use caution when prepping with flammable solutions and make sure to:
* prevent pooling.
* blot any excess solution.
* allow solution to dry thoroughly before draping the patient.
* Keep ESU pencils in holsters when not in use.
* Do not coil ESU cable or wind around clamps.
* Disconnect ESU pencil from generator if it becomes contaminated.
* Avoid "buzzing" the hemostat in a way that creates metal-to-metal arching.
Laser safety considerations
* Before surgical procedures, ensure the aiming and therapeutic beams are properly aligned.
* Ensure constant communication between surgeon and laser operator.
* Allow only the surgeon to have access to the laser foot pedal before laser activation.
* Place the laser in standby mode when-ever it is not in active use.
* Activate the laser only when the tip is under the surgeon's direct vision.
* Use surgical devices designed to minimizelaser reflectance.
* Inflate the ET cuff with methylene blue-tinted water or 0.9% sodium chloride solution during airway procedures. This practice aids in detecting a compromised cuff and oxygen leak.
First response
Attempt to smother a small fire with a gloved hand and a towel. For large fires in or on the patient:
* stop the flow of oxidizers to the patient
* remove the drapes/burning material and douse the fire with water from the back table
* restore breathing with air
* deal with the patient's injuries
* evacuate the patient if the room is dangerous from smoke or fire
* if the fire has been controlled quickly, call for help and activate the fire alarm.
Fire safety awareness is the responsibility of all members of the surgical team. OR fires can be prevented and the effects of fire can be minimized through constant diligence and communication among the OR staff.