Consider overall cost, ease when choosing evacuators

Disposables drive up costs of portable units

Clearing smoke in the OR has never been easier, thanks to new smoke evacuation technology. But hospital employee health professionals will need to consider overall cost, convenience, and effectiveness when choosing an evacuator, advises Ken Ross, senior project engineer at ECRI, a technology assessment firm in Plymouth Meeting, PA.

Early smoke evacuators were noisy and cumbersome, not unlike a nozzle attachment on a vacuum cleaner. "People are reluctant to use smoke evacuators because they think they’re like those older ones," says Kay Ball, RN, MSA, CNOR, FAAN, a perioperative educator and consultant based in Columbus, OH. "They’re really not that loud now."

Advances in technology have brought improved design of hand-held nozzles, better filtration and airflow, and less noise. Hospitals may now consider smoke evacuation wands, which incorporate the evacuation into an electrosurgery unit (ESU) pencil.

The newest technology involves stationary units that are built into the OR’s mechanical space and activated through a control switch or foot pedal. "In essence, you plug your hose or handpiece into the wall or surgical column," says Ross. The unit doesn’t take up floor space, and noise is shielded by the insulation of the wall or ceiling.

Consider all costs of each system

Each type of system has a host of advantages and disadvantages that must be carefully weighed, says Ross. For example, the basic portable units with hand-held nozzles may seem the most economical, but Ross cautions that you must consider all costs.

"Portable systems are very inexpensive to purchase. In some cases, manufacturers will practically give them to you for free," he says. "But you also buy the disposables — the filters, the handpieces, the hoses. That adds up considerably. We estimate that it could cost you $10,000 to $13,000 per year for an active hospital per unit [with very busy ORs]."

In contrast, a stationary system can cost as much as $120,000 to install and requires construction. However, stationary systems may not require disposable filters, or they may have filters with a much longer life.

"Even though the installation costs for a stationary system are very high, your cost per use becomes lower because your disposable cost is low," says Ross. "We estimate a cost per use of the stationary system of $4 to $5 per case, whereas a portable system can be anywhere from $6 to $10 per use."

The stationary systems may be particularly appealing for hospitals that are planning renovation, he notes.

The ESU pencil-based evacuation wands offer the advantage of capturing smoke close to the point of origin, which means the airflow can be lower and the noise is reduced.

Does system compromise surgeons’ dexterity?

While some surgeons may appreciate the convenience of an evacuator connected to the ESU pencil, others may balk, says Ross. "The hose puts a strain on the wrist of the surgeon," he says. "He’s trying to do this delicate operation, but his dexterity is compromised. I’ve heard stories that some surgeons will actually ask the scrub nurse for a pair of scissors and will proceed to cut the hose. There are other surgeons who love these things."

After selecting the overall type of evacuator, hospital employee health professionals should consider performance features such as air movement, filtration, noise, mobility, maintenance, and the overall cost of different models, notes Ball.

The most important message, says Ball, is that hospitals should use some type of evacuator in their ORs. The hospital’s HVAC system mixes the air with clean air but doesn’t get rid of the smoke. Surgical masks only filter particles of 5 microns or higher, while 77% of surgical plume is composed of particles 1.1 microns or smaller, she says.

"This stuff is real small, and where does it go? It goes right into your lungs, where it can cause respiratory conditions," Ball says.

[Editor’s note: Detailed evaluations of surgical smoke evacuation systems are available in Health Devices, September 1999 and April 1997 issues, from ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298. Telephone: (610) 825-6000, ext. 5888. Fax: (620) 834-1275. Web site:]