Safe Endourology Procedure Using a C-Arm Drape During COVID-19 Times - Beyond the Abstract

The outbreak of the “Coronavirus Disease 2019” (COVID-19) started in December 2019 and quickly became a sweeping and unprecedented challenge to different stakeholders all around the world. Healthcare providers, who are tasked with taking care of the critically ill patients, are themselves at risk of getting infected. They need to perform the best practices of intubation and ventilation tailored explicitly to the victims of this sweeping COVID-19 outbreak and, at the same time, adhere to strict self-protection precautions.1 COVID-19 has a wide spectrum of clinical presentation, ranging from being asymptomatic to critically ill, and ultimately death.2,3



A recent report related to 138 confirmed COVID-19 cases, 41.3% were considered acquired infection from the hospital, and more than 70% of these patients were healthcare providers.4 A high level of vigilance on the part of a healthcare provider is necessary to prevent contracting the infection especially when intubation is performed. Standard Level 3 protection should be worn by individuals performing the intubation.4-7

Orser8 wrote in his editorial that personal protection was the priority of all healthcare providers. It is very important to practice appropriate hand hygiene before and after all procedures, to limit the number of healthcare providers in the room where the patient is to be intubated, and that the most experienced anesthetist available to perform the intubation, if possible. It was better to avoid awake fiberoptic intubation as atomized local anesthetic might aerosolize the virus. It is better to plan for rapid sequence induction (RSI). It is also important to develop a robust communication system so that front-line healthcare providers could provide rapid feedback to policymakers and vice versa.

Recently we have reported the use of a sterile C-arm drape to create a protective device at the time of intubation, during the whole period of anesthesia and extubation. The drape is passed around the patient's head and spread across the head end of the table. Three apertures are created within the drape, to permit the introduction of the two hands of the anesthetist and for the endotracheal tube to exit. Intubation and extubation are carried on within the drape, which prevented the spread of air droplets and aerosol contamination.

Written by: R. B. Nerli, MBBS, MS, M.Ch1 and Shridhar C. Ghagane, MSc, PhD, MBA2

  1. Department of Urology, JN Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
  2. Urinary Biomarkers Research Centre, Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi-590010, Karnataka, India
References:

  1. Meng, Lingzhong, Haibo Qiu, Li Wan, Yuhang Ai, Zhanggang Xue, Qulian Guo, Ranjit Deshpande et al. "Intubation and Ventilation amid the COVID-19 OutbreakWuhan’s Experience." Anesthesiology: The Journal of the American Society of Anesthesiologists 132, no. 6 (2020): 1317-1332.
  2. Huang, Chaolin, Yeming Wang, Xingwang Li, Lili Ren, Jianping Zhao, Yi Hu, Li Zhang et al. "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China." The lancet 395, no. 10223 (2020): 497-506.
  3. Chen, Nanshan, Min Zhou, Xuan Dong, Jieming Qu, Fengyun Gong, Yang Han, Yang Qiu et al. "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study." The Lancet 395, no. 10223 (2020): 507-513.
  4. Wang, Dawei, Bo Hu, Chang Hu, Fangfang Zhu, Xing Liu, Jing Zhang, Binbin Wang et al. "Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China." Jama 323, no. 11 (2020): 1061-1069.
  5. Luo, Mengqiang, Shumei Cao, Liqun Wei, Rundong Tang, Shu Hong, Renyu Liu, and Yingwei Wang. "Precautions for intubating patients with COVID-19." Anesthesiology: The Journal of the American Society of Anesthesiologists 132, no. 6 (2020): 1616-1618.
  6. Nerli, R. B., and Shridhar C. Ghagane. "Safety of health-care workers during COVID-19 times." Indian Journal of Health Sciences and Biomedical Research (KLEU) 13, no. 2 (2020): 61.
  7. Nerli, Rajendra, Guruprasad Shetty, Vinayak Jannu, and Lakshmi Aishwarya. "SAFE ENDOUROLOGY PROCEDURE USING A C-ARM DRAPE DURING COVID-19 TIMES." Journal of Endourology ja (2020).
  8. Orser, Beverley A. "Recommendations for endotracheal intubation of COVID-19 patients." Anesth Analg 130, no. 5 (2020): 1109-1110.
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