FDA: 6 guidelines to prevent surgical fires

The FDA issued a safety communication May 29 on practices for healthcare providers to reduce the risk of surgical fires, including recommendations for safely using medical devices during surgery.

Most surgical fires occur in oxygen-enriched environments where oxygen concentration is above 30 percent. An oxygen-enriched environment can be created when supplemental oxygen is given to a patient in an operating room.

Open oxygen delivery systems, including a nasal cannula or mask, introduces greater risk of a surgical fire than a closed delivery system, such as a laryngeal mask or endotracheal tube. Materials that may not typically burn in room air can ignite and burn in an oxygen-enriched environment.

Six recommendations to prevent surgical fires:

1. Conduct a fire risk assessment at the start of every surgery. The highest risk procedures involve an ignition source, delivery of supplemental oxygen and use of an ignition source near the oxygen (e.g., head, neck, or upper chest surgery), the FDA stated.

2. Encourage communication among surgical staff. Healthcare professionals should ensure there is communication between the anesthesia professional delivering medical gases, the surgeon controlling the ignition source and the OR staff applying skin preparation agents and drapes, the agency stated.

3. Ensure the safe use and administration of oxidizers. Providers should assess whether their patient needs supplemental oxygen. If it is needed, particularly for head, neck or upper chest surgery, the FDA recommends titrating to the minimum concentration of oxygen necessary for maintaining enough oxygen saturation for the patient.

4. Safely use any devices that may serve as an ignition source. Providers can also consider alternatives to using an ignition source for head, neck and upper chest surgeries if high concentrations of supplemental oxygen (greater than 30 percent) are being delivered. They should also inspect all instruments for signs of insulation failure.

5. Safely use surgical suite items that may serve as a fuel source. Providers should allow enough drying time and prevent alcohol-based antiseptics from pooling during skin preparation and evaluate for pooling or other moisture to ensure dryness before draping.

6. Practice ways to manage surgical fires. The FDA offered several steps for managing a surgical fire: 

1. Stop the main ignition source.
2. Extinguish the fire, remove all drapes and burning materials and look for any smoldering materials.
3. Disconnect the patient from the breathing circuit for airway fires and remove the tracheal tube. Move the patient to safety and re-establish the airway to resume respiratory care.
4. Review the fire scene and remove any potential sources of flammable materials.

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