[CG] PRM COVID-19 guide for the anaesthetic nursing team

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COVID isolation rooms = LW rooms 9-10 

Theatre 3 for suspected / proven COVID cases

Regional anaesthesia is default in, even in cat 1 CS wherever feasible

Use donning / doffing guides with buddy for PPE

PPE – the following applies to ALL patients regardless of COVID status

  • Contact precautions
    Fluid resistant surgical mask, gloves, disposable plastic apron

  • Droplet precautions (all patients receiving spinal / epidural)
    Fluid resistant surgical mask, disposable fluid resistant gown, eye protection, sterile gloves x 2

  • Aerosol precautions (patients receiving GA or at high risk of conversion to GA) FFP3 mask, disposable fluid resistant gown, eye / face protection, sterile gloves x 2

All patients should wear a fluid resistant surgical mask

At start of each shift

  • All usual duties
    • Check anaesthetic machines
    • Check difficult airway trolley / defib
    • Ensure GA drugs / phenylephrine in all theatre fridges
    • Ensure emergency drugs on all anaesthetic machines
    • Ensure antibiotic tray(s), oxytocin 20U + 20ml phenylephrine syringe on each anaesthetic machine
    • Ensure syntometrine vial, syringe and needle on separate tray
    • Ensure usual PRM fluid / phenylephrine set-up in place in each theatre
    • Ensure pre-prepared diamorphine syringes ordered twice weekly
  • COVID theatre (theatre 3) additional checks
    • Put additional drugs on GA tray in fridge
      (Thio x 2, Sux x 2, 4 x 20ml sterile water, Rocuronium, Ondansetron, sugammadex 200mg, paracetamol 1g)
    • Ensure theatre trolley stocked with leaned supply of all usual contents
    • Ensure bottom drawer of theatre trolley has all airway equipment available
      (Mac 3 + 4, McGrath, #6 ETT x 2, #4 igel, bougie, stylet, guedel, ETT clamp)
    • Ensure isolation signs available for use

Epidural in labour ward room

  • Perform hand hygiene, surgical facemask, apron and gloves before entering room
  • Open all usual equipment for epidural onto trolley
  • Get LA bag from desk
  • Help with cleaning trolley / equipment after insertion

Theatre case - regional anaesthesia

  • Ensure isolation sign on theatre door and corridor / route to theatre
  • Ensure corridor vacated by non-essential personnel for transfers to and from theatre
  • Ensure staff have donned appropriate droplet PPE
  • Diamorphine now in pre-prepared syringe. Anaesthetic nurse to open and hold the 1ml syringe. Anaesthetist will draw up contents using a sterile syringe
  • Standard theatre clean with wipe down of surfaces after patient has left theatre
  • Clean anaesthetic machine as per protocol
  • Theatre must not be used for 12 mins after last person has left theatre

Theatre case – general anaesthesia

  • As above plus ensure all necessary staff have donned aerosol PPE and are in theatre prior to induction of anaesthesia
  • Prepare for GA as usual
  • Use checklist (on wall) – this highlights the differences for COVID patients
  • No sodium citrate
  • Inflate balloon prior to first ventilating breath
  • Avoid theatre entry / exit wherever possible within 12 mins of intubation / extubation (staff entering theatre within this time-period must wear aerosol PPE
  • Ensure mask with HME filter attached ready for extubation
  • All non-essential staff and neonate (wherever feasible) should leave theatre prior to extubation
  • No-one should leave or enter theatre within 12 mins of extubation
  • Patient will be recovered in theatre
  • Clean team to collect patient and transfer to LW room

Cell salvage may not be used in suspected / confirmed COVID cases

Last reviewed: 18 June 2020

Next review: 18 June 2021

Version: 3