The use of diathermy as a cautery

device is common practice in

perioperative environment, however

issues relating to the health

and safety of the smoke produced through

the vaporisation of tissue may still not be

recognised by practitioners. This is despite

the use of diathermy dating back to the

late 19th century (Pollack et al, 2000).

Concerns have been expressed about the

components of diathermy smoke (Health

and Safety Executive (HSE), 2012), which

contains 95% water and 5% cellular debris

(Ulmer 2008), including a magnitude of

different chemicals, some of which may

have mutagenic and carcinogenic potential

similar to that of cigarette smoke (Ortolano

et al, 2009)

Brown, Steven

Dunn, Lynda

English

University of Huddersfield Repository

University of Huddersfield RepositoryDunn, Lynda and Brown, StevenDiathermy smoke: a risk to perioperative practitioners?Original CitationDunn, Lynda and Brown, Steven (2014) Diathermy smoke: a risk to perioperative practitioners? Journal of Operating Department Practitioners, 2 (7). pp. 320-322. ISSN 1746-7357 This version is available at http://eprints.hud.ac.uk/22874/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not-for-profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/Diathermy smoke: risk to perioperative practitioners? Lynda Dunn Lecturer Practitioner, ODP, University of Huddersfield Steven Brown Course Leader ODP University of Huddersfield  The use of diathermy as a cautery device is common practice in perioperative environment, however issues relating to the Health and Safety of the smoke produced through the vaporisation of tissue may still not be recognised by practitioners.  This is despite the use of diathermy dating back to the late 19th century (Pollack et al 2000).   Concerns have been expressed about the components of diathermy smoke HSE (2012), which contains 95% water and 5% cellular debris (Ulmer 2008),  including a magnitude of different chemicals, some of which may have mutagenic and carcinogenic potential similar to that of cigarette smoke (Ortolano et al 2009).   Brown and Dunn (2013) identified 45 different compounds being present in diathermy smoke. All of these compounds were cross referenced against the COSHH list of approved workplace exposure limits as defined by the HSE (2007) of which 9 were identified as being hazardous to health, four of which are carcinogens, none of the compounds found exceeded the PEL’s outlined by the HSE (2007).    Andreasson et al (2009) found that the size of particles found in diathermy smoke was small enough to reach alveoli in the lungs and move into the cardiovascular system, and can cause inflammatory changes in the respiratory tract, nausea, carcinoma, dermatitis and cardiovascular dysfunction. He also discovered that surgical facemasks do not adequately filter particles and as such are not a suitable barrier and advise the use of an extractor.  The HSE (2012) found that the quality of air was improved when using an extractor devise.  Pillinger et al (2003) identify two different methods for extracting diathermy plume.  The first method involves simply holding a suction device near to the diathermy pencil tip, which is reliant on the experience of the assistant and uses up one of their hands.  The preferred method was the use of an integrated diathermy pencil and smoke extraction system, which operates the same as a normal diathermy pencil and would require little change to operating technique. Spearman et al (2007) found negative attitudes towards such devices amongst surgeons who said that they were too expensive and cumbersome to use.    The regulatory agencies that govern Health and Safety policy such as the OSHA in the United States and COSHH in the United Kingdom are unable produce policy on the evacuation of diathermy smoke until a study is undertaken that can conclusively determine the realistic long and short term health risks.    Al Sahaf et al (2007) advised that staff exposed to surgical smoke should be made aware of the risks.  Various nursing organisations provide guidance on the evacuation of diathermy smoke, The International Federation of Perioperative Nurses (IFPN) and the AORN both provide guidelines on the evacuation of diathermy smoke (IFPN 2011), in addition the AORN have devised a smoke evacuation tool kit as guidance for creating hospital policy (AORN 2011).  This being the case NICE, who provide national guidance to the NHS when formulating policy, have not as yet provided any guidelines regarding diathermy smoke.  There is no doubt that diathermy smoke contains compounds that are hazardous to health but it is difficult to conclude to what extent individuals are affected by these compounds.  However Al Sahaf et al (2007) state that the only ethically acceptable solution would be to inform those who are exposed to diathermy smoke on a daily basis of this potential hazard and to make them aware of the alternatives.  References  Al Sahaf O S, Vega-Carrascal I, Cunningham F O, McGrath J P and Bloomfield F J  (2007) Chemical composition of smoke produced by high-frequency electrosurgery  Irish Journal of Medical Science volume 176 pages 229-232  Andreasson S N, Anundi H, Sahlberg B, Ericsson C-G, Walinder R, Enlund G, Pahlman L and Mahteme H (2009) Peritonectomy with high voltage electrocautery generates higher levels of ultrafine smoke particles European Journal of Surgical Oncology Volume 35 pages 780-784  AORN (2011) Smoke evacuation tool kit http://www.aorn.org/PracticeResources/ToolKits/SurgicalSmokeEvacuationToolKit/ accessed on 2nd May 2011    Brown S, Dunn L (2013) Diathermy Smoke: hazardous to health? Journal of Operating Department Practitioners. 1. 2. Pages 60-64 Health and Safety Executive (2007) List of approved workplace exposure limits http://www.hse.gov.uk/coshh/table1.pdf accessed on 19th April 2011  Health and Safety executive (2012) List of symbols, abbreviations, risk and safety phrases http://www.hse.gov.uk/chip/phrases.htm accessed 19th April 2011  International Federation of Perioperative Nurses (2011) Guideline for smoke plume http://ifpn.org.uk/guidelines/1012_Smoke_Plume.phtml accessed 2nd May 2011  Pillinger S H, Delbridge L and Lewis D R (2003) Randomised clinical trial of suction versus standard clearance of the diathermy plume British Journal of Surgery volume 90 pages 1068-1071.  Ortolano G A, Cervia J S, Canonica F P (2009) “Surgical Smoke, a concern for infection control practitioners” managing infection control  pages 48-54  Pollack S V, Carruthers A and Grekin R C (2000) The History of Electrosurgery Dermatological surgery volume 26, issue 10, pages 904 - 908 Spearman J, Tsavellas G and Nichols P (2007) Current Attitudes and Practices towards diathermy smoke.  Annals of the Royal College of Surgeons of England volume 89, issue 2, pages 162-165  Chemical compoundChung et al (2010)Lin et al (2010)Andreasson et al (2008)Al Sahaf et al (2007)Pillinger et al (2003)Hassan et al (2006)Weston et al (2009)Moot et al (2007)Acetone  Acetylene Acrylonitrile  Ammonia Benzene   1-3 Butadiene  Butene Carbon monoxide Cyclohexanone Decene  Decane Di-t-butylbenzene Dodecane Ethyl acetate Ethyl acetylene Ethyl alcohol Ethyl benzene   2-Furancarboxaldehyde Formaldyhyde  Heptanal Heptane  Hexene Hydrogen cyanide isobutylene isooctane Isopropyl alcohol Methyl ethyl ketone Methyl isobutyl ketone Nonanal 1,4-pentadiene 1-pentene  Pentadecane Perchloroethylene  Propane nitrile Propene propylbenzene propylene Styrene  Tetradecane Tetradecene Toluene   Tridecane Undecane Undecene Xylene                Chemical compound PEL mg.m3 PEL ppmChung et al (2010)Lin et al (2010)Al Sahaf et al (2007)Hassan et al (2006)Weston et al (2009)Moot et al (2007) Surgery typemg.m3 mg.m3 mg.m3 mg.m3 mg.m3 ppmAcrylonitrile 4.4 2 0.03 ND TURPBenzene 3.25 1 0.39 0.012 0.02 abdominal, TUR 1-3 Butadiene 22 10 8.65 0.339TURP and abdominalCyclohexanone 41 10 0.02abdominal, verruca pilonidal sinusEthyl benzene 441 100 0.003 0.1 NDabdominal, verruca pilonidal sinusFormaldyhyde 2.5 2 ND NDHydrogen cyanide 8 5 16.3 abdominalToluene 430 100 4.6 ND 0.015breast, abdominal and TURPStyrene 191 50 0.61 0.005abdominal and TURP     

Diathermy smoke: a risk to perioperative practitioners?

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