A Smoky Room

In practice

During a breast procedure that uses the electrosurgical unit almost continuously, a haze builds over the field. The surgeon is coughing, the circulating nurse notices the smell at the door, and the scrub person, Taylor, can see smoke drifting toward the lights each time the pencil is used. A smoke evacuator is in the room, but its nozzle has slipped back along the drape, and it has been switched off during a pause and not turned back on. Taylor tells the team that the evacuator is off and the nozzle is out of position. The circulating nurse switches the unit back on. Taylor repositions the nozzle close to the operative site, within a couple of inches, and secures the tubing so it stays there without blocking the surgeon's hands. For the rest of the case, the evacuator runs whenever the pencil does. The haze clears within minutes. After the case, the tubing and filter are handled as infectious waste, a new set of tubing is used for the next patient, and the circulator notes that the filter is due for replacement under the manufacturer's schedule. At the debrief, the team agrees that the evacuator will be switched on at the start of every case where energy devices are used, not only when someone notices smoke.