TheatrePracticeStandardsGeneric1

• The active electrode must always be stored securely in a non-conductive container
when not in use.
• The active electrode must only be activated by the person holding the device.
• Active electrodes must not be used in the presence of flammable substances, including
anti-microbial skin preparations, and tinctures.
• The active electrode should not be used in the presence of intestinal gases, as these
contain hydrogen and methane, which are highly flammable.
• Head and Neck (H&N) Procedures
• During H&N procedures a careful risk assessment must be performed to assess the
proximity of the surgical field and combustible airway devices/anaesthetic gases.
Where a risk is identified, measures must be taken to reduce this risk.
• In order to avoid any risk of ignition by skin prep, only aqueous antiseptic skin prep
solution may be used.
• Careful consideration must be given to the potential accumulation of anaesthetic gases
and in particular oxygen under drapes e.g. patients undergoing procedures under local
with oxygen supplementation. Particular attention must be given to prepping, draping
and positioning the patient to reduce this risk.
• Where there is a potential risk of airway fires, the use of N²0 is not recommended as
this gas supports combustion.
• Where possible, in situations where an airway fire is a risk, closed/semi closed
anaesthetic breathing systems and cuffed endo-tracheal tubes should be used. The
Mistral jet ventilation system can be useful as it can provide variable FIO2 from 21-
100%. However, it must not be used by anyone untrained in it's use and if required,
attempts should be made to find a clinician able to use it safely.
• If the risk assessment determines the anaesthetic/surgical procedure: a potentially high
risk for igniting, then high oxygen concentrations must be avoided.
• The use of diathermy is contraindicated whilst the patient is receiving 100% oxygen.
• Draping and positioning the patient should be performed in a manner that does not
allow pooling of oxygen under the drapes.
• If facial hair is exposed, coat the hair with a water-soluble surgical lubricating jelly to
make it non-flammable.
• Additionally, moisten sponges, gauze and pledgets (and their strings) to render them
ignition resistant.
• Theatre staff should be made aware that an airway fire may occur during
tracheostomy. It is recommended that a bowl of saline is available on the surgical
instrument trolley at all times.
• Laser safety
• There is no UK legislation specific to non-ionising radiation protection. Therefore, the
following legislation is most relevant: the Health and Safety at Work etc Act 1974; the
Management of Health and Safety at Work Regulations 1999 and the Health and
Safety (Safety Signs and Signals) Regulations 1996.
• In the United Kingdom, the Radiation Protection Division of the Health Protection
Agency (HPARPD) (formerly the National Radiological Protection Board) advises the
government providing guidance and recommendations on protection from both ionising
and non-ionising radiation.
58