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• W4239839079 abstract "Anesthesiologists are often called for airway management in critical care units and patient floors. Occasionally, patients cough during passage of the endotracheal tube into the trachea or with the movement of the tube within the airway after intubation. Often, this results in expectorated secretions contacting the skin and mucous membranes of the anesthesiologist or other ancillary health care providers near the patient. During coughing, exhaled air can attain velocities of up to 965 km/hr (600 mph) (1), endangering people even at more distant locations. Exposed personnel are at risk of bacterial and viral infections, such as tuberculosis, hepatitis B or C, and human immunodeficiency virus, because these secretions often contain blood or serum secondary to infection or trauma to the airways. Even if the mucosal membranes are spared, contamination of skin on the face, neck, or arms is unpleasant and may shift attention away from patient. We use a simple system to obviate the risk of exposure during tracheal intubation of awake and/or unparalyzed patients. The endotracheal tube is attached to a Portex Fibroptic Bronchoscope Swivel Adapter (Concord/Portex, Keene, NH) which in turn is attached to an elbow adapter. If necessary, a stylette can be passed through the swivel adapter to facilitate intubation (Fig. 1). If a stylette is not needed, an elbow connector may replace the swivel adapter (Fig. 2). This arrangement will direct the exhaled air and secretions toward the bed of patient, minimizing the risk of exposure. Figure 1: Stylette passed through the swivel adapter attached to an elbow.Figure 2: An elbow connector replaces the swivel adapter.Despite the aggressive dissemination of universal precaution information by the Center for Disease Control and regulatory actions by the Occupational Safety and Health Administration, the compliance of universal precautions remains less than satisfactory (2). The universal precautions are not observed by 11%–99% of personnel in different series in literature (3–8). Complete muscle relaxation of the patient can prevent this type of contamination, but it is not possible in all settings. We have found that this simple measure is effective in preventing unnecessary exposure of personnel to patients’ secretions. NavParkash S. Sandhu MD Shirl Schaffer MD Levon M. Capan MD Jatinder S. Gill MD" @default.
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• W4239839079 date "1999-10-01" @default.
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• W4239839079 title "Prevention of Airborne Exposure During Endotracheal Intubation" @default.
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• W4239839079 doi "https://doi.org/10.1213/00000539-199910000-00058" @default.
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