Anesthesiology Department Guideline - COVID-19
Please refer to this letter from Dr. McFarland:
Good Evening,
As the situation regarding COVID 19 is in constant flux we wanted to put out guidelines for our department regarding code situations, transport, and OR cases. As you all have seen this can change daily and we will keep the most updated information in circulation to keep you all safe.
After reviewing literature from the ASA, APSF, CDC and UH please review the following for guidance:
CODE BLUE OR INTUBATE in a COVID POSITIVE OR PUI (person under investigation)
1. Take an airway box with you, make sure there is a INTERSURGICAL filter with it (picture attached) especially if you are going to CICU or Lakeside 60 as those are the designated floors at this time.
2. Upon arrival to room don your PPE including gown, N95, eye protection and gloves-this is the order suggested by hospital policy.
3. Patient should be oxygenated with a NRB- bag masking is highly discouraged to limit secretions.
4. RSI with ETT is preferred method of securing airway, LMA is next line per APSF. If unable to secure the airway with either previously mentioned methods the provider can choose to bag mask the patient with filter in place between mask and ambubag.
5. ASA is recommending the most experienced airway expert secure the airway.
6. Once ETT is placed please put an INTERSURGICAL filter between the ETT and the ambubag
7. If patient is being transported to ICU please remain help with transport as to limit persons involved. Prior to leaving the room your PPE should be removed EXCEPT for your N95 mask and gloves if you are bagging the patient. Persons who will be opening doors or securing elevators should be clean, no gloves ect.
8. While transporting please remember to use small tidal volumes as to not increase coughing and secretions in patient
TRANSPORT OF COVID POSITIVE PATIENTS OR PUI TO OR
1. Please inform the coordinator and AC when you are anticipating bringing one of these patients to the OR. We want to be able to provide support and handle your other rooms if able.
2. Patients whether intubated or not will bypass preop/pacu and go direct to the room.
3. If patient is not intubated they should be wearing a regular mask.
4. The frontliner and attending for the OR should don PPE -gown,N95, eye protection and gloves in that order upon arrival to patients room
5. Prior to leaving the patients room PPE should be removed except for N95, the person opening doors and securing elevators should be clean
6. Upon arriving to OR the team (frontliner and attending) should don PPE as above and remain in room if possible.
7. We will relieve attendings of other room duties if they are assigned to COVID POSTIVE or PUI patient as able.
8. If the attending is needed outside the room please dispose of PPE but at this time keep N95 for return to room.
9. Once surgery is complete and patient is extubated they should be recovered in the isolation room of the PACU. If the isolation room is not available recovery should take place in the OR.
1. If patient is intubated the same process applies except please take an INTERSURGICAL filter for placement between ETT and ambu bag for transport.
2. Same team should return patient to ICU following surgery
We will continue to update these guidelines if information changes. Below are the links to APSF and CDC. Special thank you to Andrew, Soozan, and Tom for helping with this. Let me know if you have questions. Have a great night.
https://www.cdc.gov/HAI/pdfs/ppe/ppeposter148.pdf
Heather McFarland, DO
Vice Chair of Clinical Operations
Director of the Operating Room
Critical Care Anesthesiologist
Associate Professor
Department of Anesthesia and Perioperative Medicine
University Hospitals-Cleveland Medical Center
Cleveland, OH 44106
216-844-7335
