Fire Prevention and Safety During Surgical Procedures

Control Ignition Sources ::

Electrosurgery

Use lowest possible power setting
Avoid long activations of ESU
Do not use ESUs to cut tracheal rings and enter airway

Low electrosurgery power settings, while not entirely eliminating the risk of a fire, will greatly reduce the risk.

Likewise, short activations of the electrosurgery generator will produce lower voltages and help reduce the risk of a fire.

During tracheostomies, electrosurgery should not be used to cut through the tracheal rings. Entering the oxygen-enriched atmosphere of the trachea could initiate an ignition incident. To avoid this hazard, surgeons should use scissors or a scalpel to cut the tracheal rings.

One fatal fire involved an endotracheal tube. The endotracheal tube was ignited during a tracheostomy. When the surgeon attempted to cut through the cartilage rings of the trachea with an electrosurgery pencil, the tube cuff was ignited. In the presence of 100 percent oxygen, the plastic tube caught fire. The surgical team, which was slow to recognize that the fire was in the airway, gave three breaths of 100 percent oxygen while trying to extinguish the fire. Each breath reignited the smoldering tube. The patient died several weeks later because of fire-related injuries.

Damp sponges are often packed in the trachea around the tube to prevent air leaks. These sponges can dry out as the procedure progresses and thus become saturated with oxygen. Keeping the packing wet throughout the procedure will reduce the risk for fire.

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