SMOKE-FREE The latest smoke evacuation devices are affordable, quiet and effective.

Your employees' lungs should not be your standard method of filtering surgical smoke out of the OR. But even though the immediate unpleasantness and long-term consequences of inhaling plume are well known, many nurses still have to justify the need for smoke evacuators to their facilities' decision makers. If you're seeking to implement safer surgical practices, the following factors might help you make a compelling case for investment in smoke-free ORs.

• Economics of the effort. Bottom line: purchasing smoke evacuators is less expensive than hiring and training new FTEs. A workplace safety hazard cascades into staffing issues when surgical personnel suffer smoke-related health problems and administrators are forced to fill in the blanks. Counter physicians' objections to the equipment with education on smoke's impact on those exposed to it all day.
• A cost-effective deal. In addition to the equipment's initial cost, remember to budget for the continuing expense of its filters, tubing and other disposable supplies. Some manufacturers may offer deals in which the evacuator is free with a contract to purchase its supplies. Purchasing the supplies non-sterile, as a component of procedure packs for cases that generate smoke, may also be possible.
• Quiet, please. Smoke evacuator manufacturers have made great strides in this area in recent years. The latest devices are a lot quieter than they used to be. If your machines are so noisy that they distract attention from OR communication, or that they go unused, they should be replaced. Settings that automatically turn the suction on and off with electrosurgery and laser use so they're not running continuously are also a big benefit.
• Efficient action. Ultra-low-penetration air (ULPA) filters are standard in smoke evacuators. They're designed to capture 99.999% of airborne particles (that is, 1 in 1 million particles escapes). But be sure that the suction pulls effectively. Is it immediately active, or does it miss some of the plume as the smoke evacuator ramps up?
• Convenience and control. You could purchase the most advanced smoke evacuator on the market, but without buy-in from frontline users, it won't be routinely used. Most physicians are satisfied by a suction handpiece that fits in their hand, that doesn't interfere with their technique or obstruct their view, and that activates easily when needed. A system that sets up easily, that signals when filter life is low, and that doesn't make filter changes difficult, often wins staff approval.
• Is portability a plus? While mobility is a benefit, keep in mind that you shouldn't have to move a smoke evacuator from room to room. You should have one stationed in every OR. Otherwise, there's a risk it'll seem like too much trouble to retrieve the equipment from another room for a smoke-generating procedure, and safer practices will remain out of reach. OSM

Blue Endo
SAFEplume
blueendo.com
(800) 233-8448
Pricing: $40 per unit, volume discounts available
FYI: Blue Endo's SAFEplume passive smoke evacuation system is a laparoscopic filter that's 99.999% effective against tissue particles, airborne bacterial and viral cells and noxious odors. The filter also helps to maintain a clear field of vision when surgical energies are used during minimally invasive procedures. Lightweight and designed with a low profile, the system features an adjustable evacuation rate of up to 12 liters per minute.

Bovie Medical Corporation
Smoke Shark II Smoke Evacuator
boviemed.com
(800) 537-2790
Pricing: not disclosed
FYI: A 35-hour, 4-stage filter (consisting of a pre-filter, ULPA filter, 24-oz. carbon filter and post-filter) lets Bovie's Smoke Shark II capture particles as small as 0.01mm with 99.99995% efficiency. Designed to work with most electrosurgical generators as well as surgical lasers, the compact unit includes 3 connection ports to accommodate a range of accessories with varying tubing sizes.

Buffalo Filter
VisiClear
buffalofilter.com
(800) 343-2324
Pricing: not disclosed
FYI: Buffalo Filter's VisiClear smoke evacuator (shown here with the PlumePen Elite suction device) features one-touch operation for its open tubing, electrosurgical pencil and laparoscopic procedure modes. It tracks filter life and warns users of occlusions. A sliding port closure also reduces the risk that they'll come in contact with contaminants. The VisiClear's color touchscreen can be operated with gloved fingers and an automatic activation device makes remote operation convenient. A fluid trap helps to keep filters effective for longer during laparoscopic cases.

DeRoyal
ExtendEVAC Smoke Evacuation Pencil
deroyal.com
(800) 251-9864
Pricing: $26 each
FYI: Designed to follow OSHA's recommendation that plume should be removed as close to the surgical site as possible, DeRoyal's ExtendEVAC puts a smoke evacuation channel on an electrocautery pencil. Its clear telescoping tip doesn't obstruct the user's view of the site, and the electrode can be extended from 1 to 6 inches, eliminating the need to change electrodes in mid-procedure. ExtendEVAC is compatible with wall suction, suction canister devices or DeRoyal's Crystal Vision Machine.

Geiger Medical Technologies
SA-1A Smoke Evacuator
geigermedical.com
(888) GEIGER-1
Pricing: $1,045
FYI: The rugged design of Geiger's recent entry into the smoke evacuator market ensures durability through years of OR use. Used in conjunction, viral filters (available with or without charcoal) that filter 99.999% of particles at 0.2 microns and odor filter cartridges make the unit suitable for plume elimination in a range of procedures. An optional on-off footswitch, reusable aluminum wand and hose stand holder are also available.

I.C. Medical
Crystal Vision 350-D
icmedical.com
(623) 780-0700
Pricing: not disclosed
FYI: The collection tube in I.C. Medical's Crystal Vision system fits over a standard electrosurgery pencil, enabling smoke evacuation to move wherever the surgeon's hand moves, and consequently wherever surgical smoke is created. What's more, a sensor automatically turns the suction on when the pencil is activated and off when it's not in use. The system signals users when tissue has blocked the suction, whether the tube is being used in open or laparoscopic procedures, and also when the filter needs to be replaced.

MegaDyne Medical Products
Mini Vac Surgical Smoke Evacuation System
megadyne.com
(800) 747-6110
Pricing: $2,500
FYI: Compact and efficient, MegaDyne's Mini Vac offers 3 adjustable flow settings for optimum filtration as well as 3 filter ports (covered for safety) to accommodate the tubing of different smoke evacuation devices without the need for adaptors. A combination of ULPA and charcoal filters delivers up to 35 hours of filtration. An optional automatic activation device is available.

Nascent Surgical
miniSquair
nascentsurgical.com
(952) 345-1112
Pricing: $40 per unit, volume discounts available
FYI: The miniSquair smoke evacuation system from Nascent Surgical attaches to most suction units to capture 99.5% of bioaerosol contaminants at the surgical site. The single-use adhesive device is affixed to dry prepped skin near the incision and covered by the drapes. Its low-profile design doesn't obstruct surgical visualization and its wide mouth doesn't require adjustments during surgery.

Stryker
Neptune 2 Waste Management System
stryker.com
(800) 253-3210
Pricing: not disclosed
FYI: While Stryker's popular Neptune 2 is widely known for its closed-canister fluid waste collection and disposal abilities, it also includes a smoke evacuation system as a standard component, so there's no need to budget for a separate suction unit. Efficiency minded surgeons can attach the Neptune E-SEP, a monopolar electrosurgery pencil with an integrated smoke evacuator. Weighing only half an ounce, the energy device serves double duty by eliminating plume at the source.

Surgimedics
Surgifresh Turbo Start-Up Package
surgimedics.com
(800) 645-7418
Pricing: $995, with volume discounts available
FYI: Your equipment budget's limitations shouldn't compromise your staff's safety. Surgimedics offers a complete smoke evacuation system for under $1,000. Their Surgifresh Turbo start-up package includes the portable, freestanding smoke evacuator unit, a multi-use ULPA filter, 5 pre-filters and 5 lengths of tubing. The separately replaceable pre-filter minimizes the wear on and extends the life of the primary ULPA filter.

Zimmer Biomet
UltrafleX Duo Fluid Cart
zimmerbiomet.com
(800) 613-6131
Pricing: $32,000
FYI: Zimmer Biomet's UltrafleX fluid waste system incorporates a smoke evacuation solution: the ViroVac Smoke Plume Evacuation System from Buffalo Filter. This portable device enables surgical personnel to bring smoke evacuation wherever it's needed. A 3-port filter, automatic activation feature and integrated fluid trap deliver versatility to handle any type of procedure.