Operating room fires can be devastating to patients and staff. The operating room environment contains the three requirements for fire: fuel, oxygen, and an ignition source. Surgical drapes, prep solutions, sponges,, and disposable plastic equipment can all can ignite in a high oxygen environment with devastating consequences. Over the last two years we have had two operating room fires. In the first, use of electrocautery in the chest cavity in a high oxygen environment caused ignition of a chest tube. In the second case, use of electrocautery in the chest caused ignition of a dry sponge.
It is difficult for staff to recognize when there is a high oxygen environment in some situations because oxygen may leak out of the ventilator circuit or lung. In a high oxygen environment, electrocautery can ignite normally safe materials creating devastatingly rapid fires. We recommend that all cases have an accurate assessment of fire risk. It is SF VAMC policy to complete the fire risk assessment sheet and follow the guidelines. Using carbon dioxide flush during thoracic or cardiac cases may reduce fire risk.
Download the Operating Room Pre-Operative Briefing Sheet (doc and pdf) -
Image 1 - Note the tube on the left hand side of the screen with carbon dioxide flush. This flush at 5 liters/minute using a filtered tube reduces the risk of a high oxygen environment and the risk of fire.
Image 2 - Electrocautery used to dissect out the left internal mammary artery prior to coronary artery bypass surgery. Note the tube on the left hand side of the screen with carbon dioxide flush. This flush at 5 liters/minute using a filtered tube reduces the risk of a high oxygen environment and the risk of fire.
We would like to thank the technical support of SF VAMC Biomedical Engineering and SF VAMC Biomedical Photography. No one was harmed in the production of the photographs or video. However, ignoring the points of the video may lead to harm.