Use of Laser In ambulatory for Urologic procedures

1. Laser Safety
For
Clinical Staff

2. What is LASER?
• LASER is an acronym that stands for "Light
Amplification by Stimulated Emission of Radiation".
• Laser light is a form of non-ionizing radiation.
• Laser equipment produces and amplifies light that has
unique properties that cannot be produced any other way.
• The light that it produces is monochromatic - it is
composed of one single color at a specific wavelength.

3. Laser Classifications
• The classifications categorize lasers according to their ability to
produce damage in exposed people, from class 1 (no hazard
during normal use) to class 4 (severe hazard for eyes and
skin)
• Necessary control measures are determined by these
classifications
• In the U.S., laser classifications are based on American
National Standards Institute’s (ANSI) Z136.1 Safe Use of
Lasers

4. LASER Class
The Stone Center Lasers are all Class 4
• The highest and most dangerous class of lasers
• Equipped with a key switch and a safety interlock
• Can burn the skin, or cause devastating and permanent eye
damage as a result of direct, diffuse or indirect beam
viewing
• May ignite combustible materials, and thus may represent a
fire risk

5. LASER Hazards
• Laser beam hazards include eye and skin burns which are due
to laser beam shining on a person's body.
• Non-beam hazards are associated with the laser equipment or
the hazardous substances released from the laser equipment,
and fumes emitted from materials exposed to laser beams,
including laser-plumes produced during surgical procedures.
Sources of laser hazards include:
• Accidental eye exposure during alignment
• Misaligned laser beam
• Lack of eye protection
• Equipment malfunction
• Improper handling of high voltage systems
• Use of unfamiliar equipment
• Improper restoration of equipment following service

6. Type of Hazards
• Eye : Acute exposure of the eye to lasers of certain
wavelengths and power can cause corneal or retinal burns
(or both). Chronic exposure to excessive levels may cause
corneal or lenticular opacities (cataracts) or retinal injury.
• Skin : Acute exposure to high levels of optical radiation
may cause skin burns; while carcinogenesis may occur
for ultraviolet wavelengths (290-320 nm).
• Chemical : Some lasers require hazardous or toxic
substances to operate (i.e., chemical dye, Excimer lasers).
• Electrical : Most lasers utilize high voltages that can be
lethal.
• Fire : The solvents used in dye lasers are flammable. High
voltage pulse or flash lamps may cause ignition.
Flammable materials may be ignited by direct beams or
specular reflections from high power continuous wave
(CW) infrared lasers.

7. Signage
• During all laser procedure you will see a warning sign
posted on the door with extra goggles/glasses for anyone
who needs to enter

8. Eyewear
• Must be worn by all personnel during the procedure
• Patients eyes need to be protected during the procedure
• All laser protective eyewear shall be clearly labeled with
the optical density and the wavelength for which
protection is afforded
• Laser protective eyewear shall be inspected for damage
prior to use
GLL Protouch

9. Lasers used at the Center
GreenLight
Laser
100watt
Holmium Laser
Protouch

10. Laser key
• Key must not be left in the switch when the laser system
is unattended
• Key kept in the specified area

11. Blast Shields
• The most common reason for a damaged blast shield is,
without a doubt, contamination on the proximal (connector)
end of the fiber. If there is enough debris on the face of the
fiber when the laser is fired, the debris will absorb the energy
and flash or burn.
• If you have a damaged blast shield you need to change both
the fiber and shield.

12. Holmium Laser Blast Shield
Blast Shield Insertion Site Holmium Fiber with Blast Shield

13. Urological Laser Procedures
• BPH
• Bladder Biopsies
• Condyloma
• Fulguration of bladder tumors
• Lithotripsy
• Strictures

14. Laser Checklist
LASER CHECKLIST

15. Procedural Practices
• Laser foot pedal
• Pedal is to be activated only by physician performing
procedure – no other foot operated device can be used by
the physician!
• Laser used correctly
• Laser in “Standby” when not in direct use
• Physician must communicate “laser on” and “laser standby”
with nurse/technician
• Laser nurse or technician at control panel for emergency shut
down

16. Procedural Practices, cont’d
• Smoke evacuator used when lasing produces particulates
• Check filter unit before use for capacity
• Check alignment of laser prior to use
• Set energy setting
• Verify “kill” switch works
• Complete Medical Record for laser use

17. Fibers
GLL Fiber
-Fiber Card
Protouch
Holmium Laser Fibers
-200
-365 (Most Commonly Used)
-550
-1000

18. Safety First