Clin Surg | Volume 5, Issue 1 | Research Article | Open Access

Bovie’s Inferno: Understanding the Causative Agents of Intra-Operative Fire

Augustus Koch1*, Joseph Bowen2 and Tamara Odom-Maryon3

1University of Washington School of Medicine, USA
2Kootenai Health, USA
3Washington State University College of Nursing, USA

*Correspondance to: Augustus Koch 

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Introduction: Fire safety is a tenant of the OR but proprietary as it pertains to hospital policy. Current literature establishes guidelines for the use of electrocautery but fails to establish ubiquitous fire rating scales based on empiric risk. Our belief is that higher Bovie power output is the most causative agent of intraoperative fires given the inert status of oxygen and fuel sources together in the OR. Methods: A porcine sample was prepped using paper drapes and a variety of antiseptic agents. Oxygen was introduced into the environment at 0 L/min, 4 L/min and 25 L/min. Electrical current was provided by the covidien force triad energy platform and bovie electrosurgical pencil. The electrical current was applied for 3 sec on cut/coag settings of 15/15, 65/50, and 150/90. The presence of fire was noted after each trial. Results: Our study suggests the most contributive component of the fire triangle is the cut and coagulation setting. With a total of 41 fire events that could pose a threat to patients, 19 of them occurred under coagulate and 22 of them under a cut current. Some of the most dangerous combinations were the use of alcohol and ChloraPrep solutions under high energy and oxygen conditions. Conclusion: Given the variables with the electrosurgical unit alone, we hope to provide a more in depth look at the most causative agent for intra-operative fires to help guide best practice and improve nationwide patient outcomes by reducing the incidence of these events through informed policy change


Koch A, Bowen J, Odom-Maryon T. Bovie’s Inferno: Understanding the Causative Agents of Intra-Operative Fire. Clin Surg. 2020; 5: 2901..

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