|
Membership Forum : COVID-19 Discussion |
|
|
|
| |
|
|
Subject : who is proceeding with elective BMT's?..
05/05/2020 12:35:40 PM
|
|
|
| anna penna |
|
Posts: 49
Location: manassas virginia |
|
|
|
|
|
|
what are colleagues doing to manage BMT? I practice in a northern virginia ASC where we do many elective BMT. Testing has been difficult to obtain; are people doing BMT? Of course wear N95 mask. How long are you waiting for air handlers to circulate air in the room before the next case proceeds? I'd love some guidance. Thanks |
|
anna m penna |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/05/2020 12:52:39 PM
|
|
|
| Niraja Rajan MD, SAMBA-F |
|
Posts: 6
Location: |
|
|
|
|
|
Hi,
We will be starting elective BMTs in the next few weeks. I just did a webinar yesterday on considerations for pediatric anesthesia. We are waiting the 21 minutes that it takes our air handlers to eliminate majority of aerosols. We are spacing the kids out at 20 minute intervals. We are phasing in by only doing 8 cases on the first try out day. There are many considerations for pre-procedure and recovery which I discussed in the webinar. I do recommend full PPE for the entire case. Mask anesthetic is OK. Understand that there would be aerosol generation. Try to have a separate recovery area for the cases. I recommend following the COVID-19 screening protocol and not doing cases that are febrile or answer yes to the high-risk questions. Testing when feasible although SAMBA recommends testing pre-surgical patients and ASA-APSF recommend forgoing testing in communities with LOW to NEGLIGIBLE community transmission rate. The webinar should be available to view on the website soon.
Niraja Rajan |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/06/2020 06:53:58 AM
|
|
|
| anna penna |
|
|
Posts: 49
Location: manassas virginia |
|
|
|
|
|
|
Thank you Dr Rajan for your response. Will you cancel a BMT with a temp of 99? Given that many of these children have underlying middle ear infections? Our hispanic community has been hit very hard with Covid-19 and many of these children come from this community. It makes me super vigilant, and more likely to cancel for a fever. I'm sorry to have missed the webinar as I was on call in our main hospital. I look forward to the replay. |
|
anna m penna |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/06/2020 07:56:33 AM
|
|
|
| Niraja Rajan MD, SAMBA-F |
|
|
Posts: 6
Location: |
|
|
|
|
|
|
Unfortunately, given the epidemiology of SARS-CoV 2 in children I would be very stringent with screening criteria. Our current temperature cut off is 100 degrees F. The kids also should not have any URI or COVID-19 screening symptoms. This may mean that a lot of them are rescheduled till they fit the criteria but that is the safest thing to do. In communities with a high infection rate it is recommended that a screening test be performed prior to surgery. |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/06/2020 01:04:04 PM
|
|
|
| Dr. David Goodman M.D. |
|
Posts: 22
Location: |
|
|
|
|
|
|
We have been doing some BMT surgeries all along. These were limited to those that the ENT felt were getting progressive hearing loss. Now that we have the ability to test our outpatients 2 days before, the kids will be tested. All are asked about symptoms, travel, and fevers on a call the day before. When they enter the surgical center their temperature is taken. We will also be using a 100 degree cut off as the above 99 to me is low. We will also be starting off at only 2-4 cases and slowly increase as PACU space allows. The PACU space in our institution is the limiting factor in what we schedule for now. |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/06/2020 01:14:56 PM
|
|
|
| Steven Butz MD, SAMBA-F |
|
Posts: 7
Location: |
|
|
|
|
|
|
I am at the Wisconsin Children's Surgicenter. We just re-opened for time-sensitive cases. As was previously described, PE tubes fit in that for risks of hearing, language, and reduction of side effects of abx. We screen on call 3 days out, we get a PCR swab test day before, and re-screen with questions and a temp on arrival. 100.4 F is our cut-off temp (38 C). We are scheduling no more than 3 per hour as the airflow rate at 12/hour will clear the room adequately. Staff are wearing N-95s and eye protection as a reflection of not being able to maintain social distancing in patient care areas. On our second day open, an asymptomatic 9-month-old swabbed positive! We cannot do that case until after 14 days, still not symptoms, and 2 (-) swabs. |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/07/2020 12:34:12 PM
|
|
|
| anna penna |
|
|
Posts: 49
Location: manassas virginia |
|
|
|
|
|
|
Steven, who at your center is ordering the test? The surgeon? You? And where are the tests being done? It looks like you may be affiliated with a large teaching hospital? Are you doing the swab at your center? These are all details at our Virginia center that have been hard to pin down |
|
anna m penna |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/07/2020 01:28:23 PM
|
|
|
| Steven Butz MD, SAMBA-F |
|
|
Posts: 7
Location: |
|
|
|
|
|
|
I am affiliated with the Wisconsin Children's Hospital in Milwaukee. I am part of the screening that they do for all cases undergoing procedures. I am fortunate that the pre-op APN puts the orders in. We can see the result on our Epic status board. Surgeon and anesthesia provider are called with (+) swab results when they come in. I admit, it is definitely easier to get a testing system in place when you are part of a relatively closed group. Right now, we are trying to make it as seamless for patients that come from 3-5 hours away. Our lab director at the hospital is working to evaluate labs in the north part of our state to see what would be acceptable results and then we have to weave those outside labs into our current system of notification. I suggest you start with something close and then see what accommodations you need to make as you expand out. Easiest for patients is if they can be swabbed at the surgeon's office, but timing is an issue there. |
|
|
|
|
|
|
Subject : Re:who is proceeding with elective BMT's?..
05/07/2020 07:23:07 PM
|
|
|
| Chhaya Patel, MD, SAMBA-F |
|
Posts: 4
Location: |
|
|
|
|
|
|
We have started doing elective cases at children’s in Atlanta too. We haven’t been testing the BMTs due to short nature of the procedure as well as testing limitations. However, we do wear N95s during the cases. We are all doing pre op screening. We also only allow one parent to accompany the child for procedure. We are continuing the parental presence during induction with gown/mask for the parent. Our ENT’s seem to order pre op covid for tympanoplasty. |
|
|
|
|
| |
