CAEP will be releasing a formal document shortly but in the meantime, here are some key considerations:
A) Is the scan clinically indicated and will the results change management?
- In Non-Respiratory concerns/low-risk COV-19 patients – standard indications apply BUT you must now do a terminal clean after use (wiping down all surfaces touched during the scan) with Accel wipes after exiting the room. Wet-time must be 1 minute.
- In Resp/COVID suspected cases, POCUS use is more nuanced. While POCUS can be used to triage and monitor COVID patients – it may or may not have a direct impact on patient disposition in your ED. In Saskatoon for example, a Hx consistent with viral URTI combined with WOB and O2 sats will likely do the trick for admission to either Medicine or ICU. POCUS may be indicated when diagnostic uncertainty and/or shock state exists. Procedural guidance should be determined on a case by case basis. In any of these instances, the machine may be exposed to aerosolized environment and a higher level of decontamination may be required (see below).
POCUS Preparation and cleaning in AGMP rooms.
- For the duration of the pandemic, remove all unnecessary equipment from your cart-based machines (we have done this at all three sites in Saskatoon)
- Consider designating certain machines as COVID-19 specific.
- Use sheaths to cover the probe and cord. These do not need to be sterile in the setting of diagnostic applications.
- Utilize single use ultrasound gel packets.
- Cover non-essential components of the ultrasound machine with drapes, gown, or plastic covering, like a plastic bag.
- Perform the scan.
- Remove drapes or bag after use and leave in the patient’s room, being mindful of not dispersing virus while disposing of the cover.
- Wipe down the entire surface of the machine with designated wipes after use inside the patient’s room, prior to doffing.
- Move the machine out of the patient room. Doff contaminated PPE and don new gloves. Then wipe down the entire surface of the machine again.
B) Do i have time to properly drape the machine and then clean it afterwards?
Take cleaning and preparation time into consideration as you decide whether or not you will use POCUS. As the list shows, you are looking at an additional 10 minutes for preparation and cleaning. Also – now is generally not the time to learn totally NEW POCUS applications. The use of a COV-19 lung protocol (linked below) is within the scope of any credentialed POCUS user and may be helpful when conventional imaging like CXR are limited.
C) Should i get a handheld POCUS device since they are easier to clean?
Health Canada has recently approved the newest handheld devices (Butterfly IQ) in light of the pandemic (and how much more easily they can be cleaned). Some departments are buying these in large numbers. My understanding is that these departments (some in Sask) have clearly defined the use and cleaning parameters for these devices. With the right processes and procedures in place , we can keep our staff and patients safe during these very challenging times.
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