It is extremely important for all surgical team members to be aware of the hazards of surgical smoke and the ways to eliminate this hazard. The article in the April 2008 AORN Journal entitled, “The hazards of surgical smoke,” by Ms. Ulmer provides valuable information on surgical smoke for the perioperative nurses who must be diligent in the evacuation of all plume.While the article provides vital information on surgical smoke, it has a misleading statement about the effectiveness of portable smoke evacuation systems. The statement in question is on page 728 and reads: “An effective portable smoke evacuation system should be able to pull 30cu ft to 50cu ft per minute to be able to capture surgical smoke”. The effectiveness of a smoke evacuator is NOT based on the cubic feet per minute air movement. In 1997, Health Devices published information from the ECRI about “Surgical Smoke Evacuation Systems.” It was stated that the criteria for smoke evacuation system efficiency were in the airborne particle reduction system exhaust performance and the odor capture and removal.

Also the smoke evacuator collection devices have been divided in the two categories of pencil-based device and hand held nozzle device. The NIOSH publication entitled Hazard controls/Control of smoke from laser/electric surgical procedures – HC11 states that “The smoke evacuator should have high efficiency in airborne particle reduction and should be used in accordance with the manufacturer's recommendations to achieve maximum efficiency. A capture velocity of about 100 to 150 feet per minute at the inlet nozzle is generally recommended.”

The ECRI testing nor the NIOSH Hazards Controls have ever recommended that 30 cu ft to 50 cu ft per minute of flow rate is necessary for the smoke evacuator to be listed as efficient. The most important criterion for the efficiency of smoke evacuation is the velocity of the air intake at the nozzle. The higher the velocity, the higher the efficiency. The flow created by the smoke evacuator, no matter how low or high (30cu ft/min, 50cu ft/min, or even 100cu ft/min) means nothing if it is not supported by high suction power which actually creates the high velocity at the inlet nozzle. The flow is also affected by the diameter of the tubing and the nozzle. Obviously the quality of the filtration is also very important as mentioned in the AORN article.

So, in summary, the true measures of the efficiency of a smoke evacuator are the capture velocity at the inlet nozzle (which should not be less then 100ft/min to 150ft/min) and the quality of the three-stage filtration as mentioned in the article. Thank you for publishing this response so that perioperative nurses understand the true efficiency ratings of their smoke evacuators.

Sincerely,

Ioan Cosmescu
President, I.C. Medical Inc.

References

1. Ulmer BC. The hazards of surgical smoke.
AORN J.2008;87(4):721-734.

2. Surgical Smoke Evacuation System
Health Devices. 1997;26(4):132-172.

3. Hazard Controls: Control of Smoke from Laser/Electric Surgical Procedures (HC11). National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/hc11.html Accessed May 6, 2008.