GP mythbuster 98: Surgical plumes

Page last updated: 23 December 2022
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Electrocautery is a medical practice or technique. It uses a heated instrument to destroy some tissue in an attempt to stop bleeding and damage. It can also be used to remove an undesired growth or minimise other potential medical harm. For example, infections when antibiotics are unavailable.

Surgical plumes (also known as surgical smoke) are potentially harmful and are produced by the electrocautery device.

Public Health England define airborne particles less than 5 microns in diameter as aerosols. They can be inhaled to the upper and lower respiratory tract. Most plumes produced by electrocautery and laser devices are less than 1 micron in diameter so by definition are aerosols.

Surgical plumes can be hazardous. They can have toxic, infectious and carcinogenic effects. They have potential to spread infection and viruses upon the respiratory tract.

Risk can be reduced using a smoke evacuator. The Health and Safety Executive recommend this.

Practices can reduce the quantity of plumes generated by:

  • using bipolar (rather than monopolar/unipolar) cautery
  • using lower power settings and
  • reducing the amount of electrocautery being used.

Staff should wear appropriate protective masks.

Services offering this service are expected to have carried out risk assessments. These should identify all risks associated with their premises and procedures. They should show active risk management.

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