OPINION

Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 100-104

Cath lab management protocol for Corona COVID-19 suspected or positive case: An institutional protocol

Kawather Humaid Al Ramadani¹, Jamila Humaid Al Saidi¹, Hatim Hamed Al Jamoodi¹, Prashanth Panduranga¹ , Safiya Al Shehi², Hifa Abdullah Al Mukhaini³, Mohammed Barakat Al Riyami^1
1 Department of Cardiology, Royal Hospital, Muscat, Oman
² Department of Pediatric Cardiology, Royal Hospital, Muscat, Oman
³ Department of Infectious Disease, Royal Hospital, Muscat, Oman

Correspondence Address:
Dr. Prashanth Panduranga
Department of Cardiology, Royal Hospital, Post Box 1331, Muscat-111
Oman

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ACCJ.ACCJ_14_20

Currently, there is a rapid worldwide spread of coronavirus infection 2019 (COVID-19). Cardiac Catheterization Laboratory staff are involved in emergency management of acute coronary syndrome including ST-elevation myocardial infarction and other emergencies. There is a paucity of Catheterization Laboratory protocols during a suspected or confirmed COVID patient intervention. Hence, to minimize the risk of spreading the virus to cardiac team members from suspected or confirmed cases of COVID-19, we present our institutional protocol, especially during ST-elevation myocardial infarction or emergency intervention.

Keywords: Cath Lab, Covid-19, personal protective equipment

Introduction

Before Procedure

• The registrar on call will activate the Cath Lab and will communicate with the team regarding the case.
• A dedicated Cath Lab for COVID patients if possible needs to be arranged. Basically, it needs to have personal protective equipment (PPE), emergency trolley with defibrillator, anesthetic equipment cart, scrub nurse table, and all other unnecessary equipment's which will not be routinely used, such as injector pump, echo machine, IABP machine, extra trolleys, sitting chair/stool, and charge connection to be removed out of the laboratory.
• The emergency or ward/intensive care unit staff shifting the patient to the Cath Lab have to shift the patient to the Cath Lab table as they are already wearing the PPE.
• All patients should be on the N95 mask. Donning and doffing of PPE is given in [Table 1] and [Table 2]. [Table 3] shows managment during interventional procedure.
• The scrub nurse after donning the PPE will do the following three attachments before putting sterile gown:



1. Electrocardiogram (ECG) electrodes: 3 leads only to the defibrillator equipment. Avoid ECG connection to regular Cath Lab monitor.
2. Defibrillator pad.
3. Intravenous normal saline drip connection to keep vein open.



• No noninvasive arterial blood pressure cuff or pulse oximeter or any other attachment needed.
• Use monoplane imaging only. It is preferred to go femoral arterial approach, as it is quick and the operator is away from the patient face.

Table 1: Scrubbing consultant + scrubbing staff nurse + anesthetist Click here to view

Table 2: Circulating staff nurse + technologist Click here to view

Table 3: During the procedure Click here to view

After the Procedure

• The doffing of PPE should be done in the corner of the procedure room in the provided bin.
• All the teams have to take a shower and change their uniform used during the case.
• Uniforms worn during on call of corona cases either confirmed or suspected should be gathered and kept in a red soluble bag covered with a red hamper bag then to be sent immediately to laundry.
• All equipment should be cleaned by alcohol and specific equipment wipes by the Cath team.
• After procedure the Cath Lab must be fumigated.