Emergency First Aid Procedures

• Flush eyes immediately withlarge amounts of water

• Get medical attention as soonas possible

• Promptly flush the contaminatedskin area with water

• Remove soaked clothing andflush skin with water

• Seek medical attention forskin irritation

Bone Cement

Eye Exposure

Skin Exposure

• Spills: remove all ignition sourcesand ventilate the area.

• Dispose of in accordance withlocal and federal regulationsas hazardous waste.

Spills and Disposal

• If a person has inhaled a largeamount of monomer vapor, movehim or her to fresh air immediately

• Perform artificial respiration ifbreathing has stopped

• Keep the person warm and at rest• Seek prompt medical attention

Respiratory Exposure

• Give immediate medical attention.• Do not induce vomiting, unlessdirected by a medical professional,and ensure the airway is clear.

• If the person is conscious, washout the mouth with water, andgive 200-300 mL of water to drink

• Adsorbents such as activatedcharcoal may be of value.

• Gastric lavage may be effectiveif performed within 4 hoursof ingestion.

Swallowing

Further Safety ConsiderationsFlammability• The liquid monomer is highlyvolatile and flammable (opencup flash point of 50°F).

• Never bring a flame, spark or otherignition source near the surfaceof the liquid or uncured cement.

• Do not expose the product or mate-rials to high temperatures.

• Cured bone cement is not a firehazard.

• Proper ventilation is important(Typical well regulated ORventilation is adequate).

• Proper storage of electrosurgicaldevices is important.

• Usual fire-fighting procedures arerequired in the unlikely event ofa fire.

• Dry chemical foam or carbondioxide extinguishers canextinguish the fire.

• Toxic gases and vapors, such as car-bon monoxide, may be released infires involving methylmethacrylate.

Rescue• Move the affected person awayfrom the hazardous exposure area.

• Do not endanger yourself, butput emergency rescue proceduresinto effect.

• Be familiar with emergency rescueprocedures and the location ofrescue equipment.

Occupational Exposure• Personnel should read and followall instructions provided by themanufacturer (Material Safety DataSheets (MSDS), container label,package insert).- Material safety data sheetsshould be accessible withinthe practice setting.

• The surgical team is exposed tobone cements through skin contactand inhalation of its vapors. Teammembers should wear safety glassesand surgical gloves during theopening, pouring and mixingof bone cement.

• Methylmethacrylate is a lipidsolvent generally classified asan irritant. The liquid monomerand its vapors should be handledwith caution.

• Excessive exposure to vapors canproduce eye or respiratory tractirritation. It may also affect theliver and have systemic reactions.

• Vacuum mixing reduces exposureto fumes.

Chronic Toxicity• There are no known chronictoxic effects.1

• Methylemethacrylate is quicklyeliminated and not stored inthe body.

• There is rapid clearance ofmonomer from the bloodstreamand a metabolic breakdown ofthe material.

OSHA Threshold Limit Values• Degree of hazard varies dependingon the concentration level of thevapor in the OR.

• The threshold limit value (TLV),for methylmethacrylate:- Time-weighted average duringan 8-hour work shift in a 40-hour work week,

- 100 parts methylmethacrylateper million parts of air (ppm) or

- 410 mg/m3 of air.• Monomer vapor concentrationsare generally measured well belowthe TLV.- Proper use of monomer doesnot appear to present a risk.

- Distinctive acridly fruity odorof bone cement is detectableat levels far below the toxicitylevel, so the material has“good warning properties.”

Exposure during pregnancy• At concentrations far in excessof those recorded in operatingrooms, methylmethacrylate vaporwas not toxic or teratogenic inpregnant mice.1

• No studies have been conductedin pregnant women on the effectsof mixing bone cement. Therefore,it is recommended that pregnantOR staff not be present during themixing of bone cement.

• Use your judgement.

Use of contact lenses• Manufacturers of contact lensesrecommend that such lenses beremoved “in the presence ofnoxious and irritating vapors.”

Skin Sensitivity• Never allow direct skin or other softtissue contact with bone cementbecause it may cause a local reactionor be absorbed.

• It is possible for fumes to penetratesome types of surgical gloves, there-fore double gloving is recommendedto reduce the risk of hypersensitivityreactions.- OR personnel who use non-latexgloves should change to naturallatex gloves before handling bonecement to prevent exposure.

References: 1 McLaughlin, R., Regan, S., Barkalow, J., Allen, M. , Difazio, C. “Methylemethacrylate: A Study of Tarotogenicity and Fetal Toxicity of Vapor in the Mouse”. JBJS (April 1978): 355-358.Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker.All other trademarks are trademarks of their respective owners or holders.MS/GS 2.5m 9/07 Literature Number: LBCPRev1SSPCopyright© 2007

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The information contained in this documentis intended for healthcare professionals only.