Dr Quentin Ainsworth FRCA, Mr Richard Purchon, RODP
“The following article is intended to describe a practical adaptation of closed-circuit suction catheters.”
This is in order to facilitate the safe practice of Bronchoscopy in Endotracheal, Endobronchial and Bronchial Blockers for direct visualisation of the carina. The aim is to minimise the risk to both the anaesthetic practitioner and the Anaesthetist while conducting these high-risk aerosol generating procedures in patients suspected of or confirmed to be Covid 19 positive.
This adaptation requires the use of:
A)
Covidien DAR, closed suction system replacement catheter, T-Piece, EndoTracheal length 12Fr x 580mm.
B)
Ambu aScope 4 Broncho Slim 3.8/1.2 single use Flexible Endoscope.
The single use catheter packaging contains a three-port catheter mount with a rotating bayonet valve for attaching the suction catheter, and a packet containing additional rubber caps.
In order to convert the closed system suction for use with the flexible Bronchoscope, you will need to follow the steps outlined below.
Procedure
1. Disengage the blue sheath cover collar at the proximal end of the closed suction.
2. Remove the suction catheter from the sheath.
3. Invert the blue collar and pass the sheath through and back over the top of the blue collar.
4. Utilising the additional catheter mount port cap. Place the cap over the blue collar trapping the sheath between the two.
5. Tape the cap into place and make a small hole in the top through which the tip of the bronchoscope can be passed. Utilise a small Opsite to stick the proximal end of the sheath down firmly so that there is no risk of inadvertently withdrawing the bronchoscope from the sheath.
This simple adaptation of the closed-circuit suction enables the safe practice of:
EndoTracheal Bronchoscopy for Surgical Tracheostomy.
Endobronchial Bronchoscopy for thoracic surgery or Oesophagectomy.
By utilising two closed systems, and Covidien Mallinckrodt 37 / 39 Left Double lumen endobronchial tubes.
Bronchial Blocking via EndoTracheal tube
Utilising the additional end cap to close the third port and a Cook Medical Arndt Endobronchial blocker set.
This system was devised in early March 2020 in order to facilitate lobectomy in a patient suspected of being Covid 19 positive by the authors.
It has since been used successfully for surgical tracheostomy on patients that have previously tested positive for Covid 19 in adult intensive care, who are currently on long term ventilation.
This is presently the method of choice being utilised at the John Radcliffe hospital in Oxford, however, further developments in this technique may be required as procedures change.
