Abstract
As an aerosol and droplets generating procedure, tracheostomy increases contamination risks for health workers in the coronavirus disease context. To preserve the health care system capacity and to limit virus cross-transmission, protecting caregivers against coronavirus infection is of critical importance. We report the use of external fixator equipment to set up a physical interface between the patient’s neck and the caregiver performing a tracheostomy in COVID-19 patients. Once the metal frame set in place, it is wrapped with a single-use clear and sterile cover for surgical C-arm. This installation is simple, easy and fast to achieve and can be carried out with inexpensive material available in every hospital. This physical interface is an additional safety measure that prevents the direct projection of secretions or droplets. It should, of course, only be considered as a complement to strict compliance with barrier precautions and personal protective equipment.
Protective screen
After China, the whole world is now facing the coronavirus disease 2019
(COVID-19) pandemic. This unprecedented outbreak is straining health
systems, especially the intensive care units, since around 15% of the
hospitalized patients require critical care, and in many cases prolonged
respiratory support 1. In these patients, tracheostomy
may be indicated for individual considerations, such as facilitating
respiratory assistance weaning or after a first failed extubation
attempt. In the context of intensive care units’ overload, tracheostomy
can also be considered for community benefit, since it enables to reduce
sedation depth, intensive care unit length of stay, and may facilitate
patients’ transfer outside of intensive care units, for instance in
ventilatory weaning units.
Yet, as an aerosol and droplets generating procedure, tracheostomy
increases contamination risks for health workers in the coronavirus
disease context 2. To preserve the health care system
capacity and to limit virus cross-transmission, protecting caregivers
against coronavirus infection is of critical importance3. Good practice recommendations have been published
in order to improve staff safety when performing a tracheostomy in
COVID-19 patients 4. We also read with interest the
practical tips reported in Head & Neck by Vargas et al to limit
aerosolized secretions production, such as using a double lumen
endotracheal tube to perform percutaneous tracheostomy5.
Our turn, we would like to report a tip that we’ve implemented in our
department for surgical or percutaneous tracheostomy, which can also be
used to change tracheostomy cannula (figure 1). We use external fixator
equipment to set up a physical interface between the patient’s neck and
the caregiver. Once the metal frame set in place, it is wrapped with a
single-use clear and sterile cover for surgical C-arm. The dimensions of
the installation can be adjusted to the patient; in our experience, it
is important to make the structure high enough in order to be able to
work easily below it. This installation is simple, easy and fast to
achieve and can be carried out with inexpensive material available in
every hospital. In addition, operating room equipment is currently
widely available since the planned surgical activity has decreased
significantly. After use, this device is simple to be decontaminated,
and can also be sterilized if required.
This physical interface is an additional safety measure that prevents
the direct projection of secretions or droplets. It should, of course,
only be considered as a complement to strict compliance with barrier
precautions and personal protective equipment 4,6.