Interventional radiologists modify protocol for coronavirus disease
(COVID-19) pandemic

Date:
June 3, 2020
Source:
American Roentgen Ray Society
Summary:
Radiologists who perform cross-sectional interventional procedures
can take several steps to minimize the risks to patients and
radiology personnel, including screening referred patients to
decide which procedures can be postponed, using appropriate
personal protective equipment (PPE), minimizing the number of
people involved in procedures, preserving PPE when possible,
and applying proper room and equipment cleaning measures.



FULL STORY ==========================================================================
An open-access article in the American Journal of Roentgenology
(AJR) details myriad practical updates that radiologists performing cross-sectional interventional procedures should institute to minimize
risks for patients and imaging personnel alike during the coronavirus
disease (COVID-19) pandemic.


========================================================================== "Cross-sectional interventional procedures are performed under CT,
ultrasound, fluoroscopy, or MRI guidance and include fluid aspiration, (thoracentesis, paracentesis, and fluid collections), drainage catheter placement, percutaneous biopsy, and tumor ablation," explained lead author Ghaneh Fananapazir at the University of California Davis Medical Center.

All of these procedures require appropriate donning and doffing of
personal protective equipment by every member of the IR team -- physician, trainee, nurse, technologist -- and some procedures may require admitting
the patient for management of postprocedure complications, necessitating
a hospital bed and auxiliary resources.

Thus, for procedural delays that will not adversely affect patient
outcome, Fananapazir and colleagues proposed the following tiered
approach for both outpatient and inpatient scenarios: urgent procedures, procedures that should be performed within 2 weeks, procedures that
should be performed within 2 months, and procedures that can safely be
delayed 2 or 6 months.

"Each procedure request must be triaged into a tier on a case-by-case
basis," Fananapazir et al. warned, "because clinical circumstances
can dictate one procedure as urgent, whereas different clinical data
may render the same procedure safe to delay." When considering any
procedural delay, Fananapazir's team strongly recommended consultation
with the referring physician, who may have insights not available to
the interventional radiologist.

Wherever possible, procedures should be performed bedside in
COVID-19 units (or patient rooms, should no dedicated COVID-19 unit
exist). Regarding ultrasound- guided procedures, specifically, a mobile ultrasound unit can be left in place in the ICU or the COVID-19 unit --
"used for interventional procedures, guidance for vascular access, or point-of-care thoracic and nonthoracic ultrasound," wrote Fananapazir
et al. Ultrasound probes should be sterilized according to manufacturer guidelines.

Fananapazir's team also cautioned against CT technologists or sonographers entering the procedure room. Ideally, all anticipated IT tray supplies
should be acquired before the procedure commences, covered with a sterile plastic drape, and opened only to the extent needed.

Additionally, patient interaction during the informed consent
interview can be limited by obtaining consent in the procedure room
or using documented oral consent in the medical record. "Both of
these modifications to the consent process are outside of standard
regulated practice," the authors of this AJR article noted, "therefore, establishment of hospital-wide frameworks may be needed."

========================================================================== Story Source: Materials provided by American_Roentgen_Ray_Society. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Ghaneh Fananapazir, Meghan G. Lubner, Mishal Mendiratta-Lala,
Benjamin
Wildman-Tobriner, Samuel J. Galgano, Ramit Lamba, J. Louis Hinshaw,
Olga R. Brook. Reorganizing Cross-Sectional Interventional
Procedures Practice During the Coronavirus Disease (COVID-19)
Pandemic. American Journal of Roentgenology, 2020; 1 DOI:
10.2214/AJR.20.23227 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/06/200603132554.htm https://www.sciencedaily.com/releases/2020/06/200603132554.htm

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