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Operating Room Fire Prevention: Creating an Electrosurgical Unit Fire Safety Device

Culp, William C. Jr MD; Kimbrough, Bradly A. BA; Luna, Sarah AA; Maguddayao, Aris J. AA

doi: 10.1097/SLA.0000000000000654

Objective: To reduce the incidence of surgical fires.

Background: Operating room fires represent a potentially life-threatening hazard and are triggered by the electrosurgical unit (ESU) pencil. Carbon dioxide is a fire suppressant and is a routinely used medical gas. We hypothesize that a shroud of protective carbon dioxide covering the tip of the ESU pencil displaces oxygen, thereby preventing fire ignition.

Methods: Using 3-dimensional modeling techniques, a polymer sleeve was created and attached to an ESU pencil. This sleeve was connected to a carbon dioxide source and directed the gas through multiple precisely angled ports, generating a cone of fire-suppressive carbon dioxide surrounding the active pencil tip. This device was evaluated in a flammability test chamber containing 21%, 50%, and 100% oxygen with sustained ESU activation. The sleeve was tested with and without carbon dioxide (control) until a fuel was ignited or 30 seconds elapsed. Time to ignition was measured by high-speed videography.

Results: Fires were ignited with each control trial (15/15 trials). The control group median ± SD ignition time in 21% oxygen was 3.0 ± 2.4 seconds, in 50% oxygen was 0.1 ± 1.8 seconds, and in 100% oxygen was 0.03 ± 0.1 seconds. No fire was observed when the fire safety device was used in all concentrations of oxygen (0/15 trials; P < 0.0001). The exact 95% confidence interval for absolute risk reduction of fire ignition was 76% to 100%.

Conclusions: A sleeve creating a cone of protective carbon dioxide gas enshrouding the sparks from an ESU pencil effectively prevents fire in a high-flammability model. Clinical application of this device may reduce the incidence of operating room fires.

A polymer sleeve device for the electrosurgical unit pencil can enshroud the active pencil tip with carbon dioxide, thereby displacing oxygen and removing 1 leg of the fire triad. This surgical fire prevention device effectively mitigates the risk of fire in a high-flammability test model.

From the Department of Anesthesiology, Texas A&M University Health Science Center College of Medicine, Scott & White Hospital, Temple, TX.

Reprints: William C. Culp, Jr, MD, Department of Anesthesiology, Texas A&M University Health Science Center College of Medicine, Scott & White Memorial Hospital, 2401 S 31st St, Temple, TX 76508. E-mail:

Disclosure: Supported, in part, by the National Science Foundation (Arlington, VA) under grant no. 0855343; the Texas A&M University College of Medicine Undergraduate Research Award (College Station, TX); the Scott & White Resident Mentorship Award (Temple, TX); and by institutional, departmental, and investigator sources. All authors have no potential conflicts of interest, except for William C. Culp, Jr., who has rights to this patent-pending device. This study was exempted from IRB oversight.

An abbreviated abstract of this article was presented at the Society of Cardiovascular Anesthesiologists Annual Meeting in New Orleans in March 2014.

© 2014 by Lippincott Williams & Wilkins.