OR Lasers, Info Please

[mcmike55]

I come to you,,,,the great ALLNURSES.COM Community for some info.

We bring our laser's in on a per-case basis. CO2, holmium, green light PVP, etc.

We've worked with one or two local companies for several years and gotten along well. Recently, a new doc asked (sort of) that we use the company that he is accustomed to. He added that he wanted nothing to do with the company we were currently using, by the way.

Anyway, long story short, I'm not sure about these guys.

Day one, they brought in a holmium laser fiber to use for a lithotripsy via cystoscope. They pulled it out of a baggie, and said that we could just "wipe it off with alcohol, that's what everyone else does.":eek:

Their stand was that the fibers need to be "cleaned" or what ever they called it, after each use, and they can't sterilize them.

We didn't do it, demanding a fresh, sterile wrapped fiber.

Now the company and the doc think we're nuts and troublemakers, and we sort of think the same about them!!

Any thoughts???

Mike

[openheartmary]

WHAT???????????? Of course, the fibers need to be sterlized!!!!!!!!!!

Reusable fibers can be ran in the autoclave 10/1 cycle. Or, tell the doc and the company you will use only disposable fibers.

[brewerpaul]

Would YOU want a non-sterile fiber in your GU system??? I didn't think so! We use either disposables, or sterilizable ones which can be reprocessed a certain number of times (6?)

[ewattsjt]

It should be disposable or reusable following the manufacturer’s directions as well as facility policies. Also it should be reported to the proper chain of command and followed up. I am sure that infection control or whatever your equivalence is would love to hear about that. Alcohol doesn’t kill all spores and is ineffective against certain microbes such as C. diff. We use it for surgical foam in when scrubbing because microbes on our hands are reduced to an irreducible minimum meaning that some are still there and thus we wear sterile gloves protecting both ways. The alcohol foam is only to be used after an initial scrub. It is not to be used after restroom breaks, eating, leaving the OR suite etc.. because it is not as effective as people think. So even if it was allowed; alcohol would not be the proper agent.

Even the laryngoscopic blades that anesthesia use are sterilized between patients or used as disposable (at least that is how it is supposed to be). T&A instruments, sinus instruments, myringotomy sets, cysto instruments, etc are supposed to be processed sterilely between patients even if it isn’t a sterile procedure because of the possibly of cross contamination of harmful microbes. I personally can’t see why a laser fiber optic would be different.

[brewerpaul]

Can you say UTI? In the bladder would be bad enough... what about a non-sterile fiber being passed all the way up into the kidney? No way!

[mcmike55]

Thanks for the input!!! I had a feeling "everyone does it this way" wouldn't stand up here!!!

Our problem sterilizing them in house is that we must have written sterilization instructions. Just wondering if these guys would be able to provide such info.

I'll have to look into this one.

Got another one!!

We were doing green light laser PVP's using a Laserscope laser.

In between cases, the rep. left the machine up and running,,on stand by mind you,,,but with the key still in!!!!!

He told the scrub tech, that he wanted to leave the OLD, USED fiber in place until the next pt came in, then swap out to a new fiber.

Any way, the boss came in and said no way!

My thought is that he was being lazy, and didn't want to go through the shut down and restart with a new card/fiber. I think he was just going to try to do a quick swap, before the machine knew what was happening.

But, I'll admit, that I don't know the specifics on the new high power PVP laser.

So I'm not totally sure.

We've got a few PVP's scheduled in the next couple weeks,,,,,right now, I'm tempted to "pull rank" on the guy and insist that he shuts in down and pulls the key, in between cases!

Mike

[openheartmary]

The key is never to be left unattended in the laser. ANSI requires one person be responsible for operating the laser and to have no other responsibilities.

[openheartmary]

I don't know if we are allowed to refer to a specific company's website, but I think you guys need a laser safety officer to be responsible for all safety measures concerning operation of the lasers at your facility.

[mcmike55]

OHM,,,I totally agree.

We've always relied on the rep from the company that brings in the laser to know what they are doing.

My training is strongest in CO2 lasers,,,,I'm less familure with the newer lasers like the high power PVP.

But still.....it seems like they are trying to cut corners they shouldn't be!!!

They are new to us,,,and I'm just not sure about them!

Problem is...their boss has been with them, and he's just as bad,,,and the doc seems to just love 'em!

Mike

[Nikki Nurse]

Does the doc have some sort of "vested interest" in the quacks? Could it be that he actually owns the lasers and has hired these folks to run them? He would then be collecting the rental fees from your facility to pad his own pocket. It wouldn't be the first time that I had heard of this sort of thing.

I have heard stories of physicians owning a "company" who supplies different "equipment" and then refusing to use any other company...get the drift? Might be something that you want to have checked out by your facility.

[Nikki Nurse]

Is there any possibility that this doc has a "vested interest" in this laser company?

[orbabe]

Always think of you as the patient....would you want a "clean" fiber used on you versus one that is "sterilized?" We are our patient's advocate....do not use any fiber that is not sterilized properly (we use disposable fibers)....get your OR Director and/or laser safety officer involved if necessary. Also, review your facility's laser policy. Good luck!