LASER USE & SAFETY
THIS PRESENTATION WILL COVER:
BASIC LASER ENERGY
TYPES & CLASSIFICATIONS
POTENTIAL HAZARDS
REGULATIONS & SAFETY
BASIC LASER ENERGY
LIGHT
AMPLIFICATION BY
“STIMULATED”
EMISSION OF
RADIATION
LASER IS AN ACRONYM FOR
WAVE NATURE OF LIGHT
Light is an electromagnetic wave.
Different wavelengths in the visible spectrum are seen by the eye as different colors.
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Incident Photon
Excited Atom
Stimulated Photon
same wavelength
same direction
in phase
Incident Photon
Early 1900’s, Einstein described a theory that involved stimulation of matter to cause the release of energy.
CHARACTERISTICS OF LASER LIGHT
The combination of these three properties makes laser light focus 100 times better than ordinary light
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LASER COMPONENTS
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Radio
Long Wavelength
Short Wavelength
Gamma Ray
X-ray
Ultraviolet
Infrared
Microwaves
Visible
ELECTROMAGNETIC SPECTRUM
Lasers operate in the ultraviolet, visible, and infrared.
Radio
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A FEW OF
ALASKA’S LASERS
ALASKA NATIVE MEDICAL CENTER
HOLMIUM, IRIDEX
ALASKA REGIONAL HOSPITAL
CO2, HOLMIUM, GREEN LIGHT(KTP)
BARTLETT MEMORIAL HOSPITAL
CO2, HOLMIUM, GREEN LIGHT
FAIRBANKS MEMORIAL
CO2, KTP, HOLMIUM
PROVIDENCE HEALTH SYSTEMS ALASKA
C02, KTP, HOLMIUM, GREEN LIGHT, ENDO OPTIC
ALASKAN LASERS
TYPES:
CO2
KTP
DIODE
HO:YAG
HE:NE
CO2 LASER
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Lasers are classified according to the level of HAZARD that is possible during normal operation.
Class 1 Incapable of causing injury during normal operation
Class 1M Incapable of causing injury during normal operation
unless collecting optics are used
Class 2 Visible lasers incapable of causing injury in 0.25 s.
BAR CODE SCANNERS
Class 2M Visible lasers incapable of causing injury in 0.25 s
unless collecting optics are used
Class 3R Marginally unsafe for intrabeam viewing; up to 5 times the class 2 limit for visible lasers or 5 times the class 1 limit for invisible lasers (RED LASER POINTERS)
Class 3B Eye hazard for intrabeam viewing, usually not an eye
hazard for diffuse viewing (MEDICAL LASERS)
Class 4 Eye and skin hazard for both direct and scattered exposure
MOST MEDICAL LASERS
LASER CLASSIFICATION SUMMARY
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CLASS 4 LASER Hazard Classification
Class 4 lasers above 500 milliwatts in power can injure you if viewed directly or by viewing either the specular and diffuse reflections of the beam.
These lasers can also present a fire hazard.
A danger sign will label this laser.
Eye and skin protection are required.
(The medical lasers we use!)
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LASER HAZARDS
17
POTENTIAL FOR:
EYE INJURIES
TISSUE BURNS
PLUME INHALATION
FIRE
ELECTRICAL
(To name a few)
HAZARDS
THIS IS A BIG HAZARD
BUT PREVENTABLE!
EYE INJURY
TYPES OF LASER EYE EXPOSURE
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LASER SPECTRUM
10-13 10-12 10-11 10-10 10-9 10-8 10-7 10-6 10-5 10-4 10-3 10-2 10-1 1 10 102
LASERS
200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 10600
Ultraviolet
Visible
Near Infrared
Far Infrared
Gamma Rays X-Rays Ultra- Visible Infrared Micro- Radar TV Radio
violet waves waves waves waves
Wavelength (m)
Wavelength (nm)
Nd:YAG
1064
GaAs
905
HeNe
633
Ar
488/515
CO2
10600
XeCl
308
KrF
248
2w
Nd:YAG
532
Retinal Hazard Region
ArF
193
Communication
Diode
1550
Ruby
694
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Alexandrite
755
Visible and Near-Infrared Radiation causes Retinal burn
Mid and Far Infrared – causes damage to the cornea by increased temperature in tears and tissue water. Mid Ultraviolet – causes photokeratitis (welders flash)
Near Ultraviolet – Contributes to certain forms of cataracts Xenon Chloride Excimer: Instant cataract, 308 nm pulsed laser
MULTIPLE PULSE RETINAL INJURY
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HAZARDS CONTINUED:
SKIN – INADVERTENT, REFLECTED BEAM
PLUME – TOXIC, SIMILAR TO ESU SMOKE
FIRE – RELECTED BEAM, DRAPE,SOLUTIONS,
METHANE GAS, ENDOTRACHEAL TUBE
ELECTRICAL –HIGH- VOLTAGE EQUIPMENT
FLUIDS TOO CLOSE
ALEXANDERS CARE OF THE PATIENT IN SURGERY, 2011
REGULATIONS & SAFETY
The Federal Laser Product Performance Standard (FLPPS)
of the Center for Devices and Radiological Health (CDRH)
This is federal law and applies to the manufacture of lasers.
The American National Standard for Safe Use of Lasers (ANSI Z136.1) This is a VOLUNTARY Standard that applies to the use of lasers.
It is “recognized by” :
The Occupational Safety and Health Administration (OSHA)
IEC 60825 International Standard
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LASER CONTROL MEASURES
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ANSI Section 4.1
“Control Measures shall be devised to reduce the possibility of exposure of the eye and skin to hazardous levels of laser radiation.”
Types of Control Measures
Engineering
Administrative
Procedural
Protective housing and service panel Interlocks on the protective housing Door interlocks and remote-control connector Beam attenuators and beam shutters
Key switch or padlock Filtered viewing optics and windows Emission delay
Warning lights, emission indicators Beam enclosure
Controlled beam path Laser controlled area Beam stops Remote firing and/or monitoring
Control Measures for Class 3b and Class 4 Lasers
Engineering Administrative PPE
THE LASER SAFETY OFFICER (LSO) IS RESPONSIBLE FOR MAKING SURE CONTROL MEASURES ARE IN PLACE
When talking about safety, here are a few terms to consider:
MAXIMUM PERMISSIBLE EXPOSURE
NOMINAL HAZARD ZONE
OPTICAL DENSITY
A COUPLE OF LASER TERMS
MPE limits indicate the greatest exposure that most individuals can tolerate without sustaining injury.
MPE depends on
Wavelength
Output energy and power
Size of the irradiated area
Duration of Exposure
Pulse Repetition Rate
Useful for determining optical densities for eyewear, filters or windows.
MAXIMUM PERMISSIBLE EXPOSURE
Nominal Hazard Zone (NHZ)
This zone describes the region within which the level of direct, reflected, or scattered (diffuse) laser radiation is above the allowable MPE.
KEY: Consider ENTIRE OR Room AS NHZ
Optical Density (O.D.)
This is the ability of material to absorb light.
You will see this on the goggles/glasses.
SAFETY
WHO HAS PRIMARY RESPONSIBLITY FOR LASER SAFETY ANY TIME A CLASS 4 LASER IS OPERATED?
The person operating the laser always has the primary responsibility for all hazards associated with laser use.
What safety precautions are required?
DOORS:
SIGNS ON ALL ENTRANCES THAT STATE TYPE
OF LASER W/ MATCHING GLASSES
ENTIRE ROOM CONSIDERED WITHIN NHZ!
CONTROL OF TRAFFIC IN ROOM
WINDOWS:
COVERED (EXCEPTION – CO2 LASERS)
EASIEST TO REMEMBER TO ALWAYS COVER!
KEY MUST BE REMOVED WHEN LASER IS NOT IN USE!
CONTROLLED ACCESS
CLASS 4 LASER
ND:YAG 1064 nm
100 Watts Max. Average Power
Eyewear Required: OD > 5 @ 1064 nm
VISIBLE and/ or INVISIBLE LASER RADIATION-AVOID EYE OR SKIN EXPOSURE TO DIRECT OR SCATTERED RADIATION.
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Controlled Area Warning Sign
LASER SAFETY EYEWEAR
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WAVELENGTH/ O.D. MATCHES TYPE OF LASER
DO NOT USE COLOR AS YOUR CHOICE!
USE GLASSES WITH SIDE SHIELDS
HANG WITH LASER SIGNS AT EACH ENTRY
USE OF FILTERS, FIXED OR SEMI-PERMANENT IN MICROSCOPES
CLEAN/ INSPECT. REPLACE IF QUESTIONABLE
EYE PROTECTION
UTILIZE EVACUATION SYSTEM FOR 0.1 MICRONS W/ FILTERS (ULPA/ HEPA)
USE OF LASER MASKS (O.1 MICRONS)
HOLD NOZZLE CLOSE TO SOURCE OF PLUME
DISCARD FILTERS AS BIOHAZARD
SMOKE EVACUATION
NO AHCOHOL/ NO POOLING DURING PREP
NO LIQUIDS ON MACHINE
NO FLAMMABLE OINT ON PATIENT EYES
WATER/SALINE ON FIELD
COVER ANAL AREA TO BLOCK METHANE
FIRE EXTINGUISHER IMMEDIATELY AVAILABLE
ENDOTRACHEAL TUBE FIRE:
STOP ANES GASES
EXTINGUISH FLAMES W/ NACL & REMOVE TUBE/ SALINE FLUSH AVAIL
READY TO DO BRONCHOSCOPY/ TRACH
EUIPMENT FIRE: SHUT OFF POWER SOURCE
FIRE SAFETY
FDA APPROVED, NON FLAMMABLE, LASER-RESISTANT ( OR WRAPPED W/ SAME)
DO NOT USE PVC TUBES
INFLATE CUFF WITH SALINE (TINT W/ METHYLENE BLUE)
EXTERNALLY PROTECT WITH WET COTTONOIDS
USE LOWER CONCENTRATION OF OXYGEN (LESS THAN 30%) OR ROOM AIR
ENDOTRACHEAL TUBES
CHECK ALL CORDS AND CABLES FOR DEFECTS.
NO LIQUIDS NEAR LASER .
FOOT PEDAL COVERED.
EXTENSION CORDS NOT EVER USED!.
CONTROL TRAFFIC AROUND CORDS AND FIBERS.
EMERGENCY SHUTDOWN PROCDURE
ELECTRICAL SAFETY
RECOMMENDED THAT THERE BE A DEDICATED LASER OPERATOR FOR EACH PROCEDURE
CHECK P&P AT EACH FACILITY
STANDBY USED LIBERALLY. DIRECT CONVERSATION BETWEEN SURGEON AND LASER OPERATOR
KEEP FOOT PEDALS SEPARATED
SAFE PRACTICE
DOCUMENTATION
LASER SAFETY CHECKLIST
LASER LOG
RECAP
BASIC LASER ENERGY
TYPES & CLASSIFICATIONS
POTENTIAL HAZARDS
REGULATIONS & SAFETY
“CAROL DIDN’T USE HER SAFETY EYEWEAR..
…..NOW SHE DOESN’T NEED IT.