American College of Surgeons
Southwestern Pennsylvania Chapter

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How Do I Manage Surgery for COVID-19 PUI/Confirmed Patients?

March 23, 2020 1:50 PM | Jim Ireland (Administrator)

It is important to be prepared for the potential need to operate on a Coronavirus Disease 2019 (COVID-19) person under investigation (PUI) or a COVID-19 patient. Preparation of a specific operating room (OR) and detailed education of the entire OR team who will be providing care for these patients during their procedure is imperative, without using stock protective equipment. The specific roles and responsibilities of all OR team members must be clear, with a common goal of minimizing the spread of infection to health care workers.

  • Develop a dedicated COVID-19 OR to control the spread of the disease
  • Empty OR of all nonessential materials
  • Consider a negative pressure anteroom with separate access if possible
  • Anteroom is used for donning/doffing of personal protective equipment (PPE) and separate OR carts for the COVID-19 OR
  • Separate OR airway cart; specific airway guidelines for COVID-19 PUI/confirmed patients
  • Separate OR equipment cart
  • Separate OR medication cart
  • Runner outside OR for drugs, devices, equipment
  • If intubation required for OR procedure, recommend intubation in negative pressure room prior to OR; avoid intubation in OR
  • Use dedicated transport ventilator if being transported on mechanical ventilation (ambulatory bag with viral filter, if ventilator unavailable)
  • Additional heat and moisture exchange (HME) filter and viral filter on expiratory limb of anesthesia machine circuit
  • Consider additional viral filter on expiratory limb of anesthesia machine circuit
  • Minimize airway circuit disconnection, endotracheal tube (ETT) must be clamped if any circuit disconnection planned
  • Special PPE for OR (N95 or OR powered air-purifying respirator (PAPR), goggles or face shield, gown, boot covers)
  • Provide appropriate PPE education (CDC guidance copied below) and post in anteroom in OR
  • Must use N95 or OR PAPR for all aerosol-generating procedures
  • Extubation should occur in a negative pressure intensive care unit (ICU)/ward room if possible
  • Recover patient in the negative pressure ICU/ward room or in the dedicated COVID-19 OR if negative pressure room not available
  • Consider dedicated OR teams to manage COVID-19 patients in the OR with detailed education
  • Consider performing procedures in negative pressure rooms with anesthesia team support if possible

Following are links to infographics from other sources that offer additional salient details:

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