PMC:7146662 / 2342-5628
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7146662","sourcedb":"PMC","sourceid":"7146662","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7146662","text":"Protocol and set-up\nAt our institution, an anteroom is used, directly abutting our negative pressure operating room, for donning and doffing of personal protective equipment (PPE), including protective boot covers, a sterile gown, under gloves, a surgical mask, powered air-purifying respirators (PAPRs), and an overlying pair of sterile gloves. On transfer to the operating room from the ICU, the patient is accompanied by an anesthesia provider in full PPE. Once in the operating room, the patient is placed in the supine position on the operating table and draped in the usual sterile fashion with a thyroid drape.\nNext, a magnetic instrument mat is placed overlying the patient’s upper chest. An Omni-Tract retractor is mounted to the bed at the level of mid-abdomen, opposite the surgeon. The retractor arms are placed in a wide-V configuration, over the upper body. The Ecolab Scope Pillow Warmer Drape is a clear plastic material that is stretched over the retractor arms, forming a barrier between the operative field and the surgeon, while still allowing for good visualization of the operative field. The drape is then secured with snaps to the self-retaining retractor to maintain the tightness of the drape; this will improve visibility (Fig. 1 ).\nFigure 1 An Omni-Tract retractor mounted to the bed at the level of mid-abdomen, with retractor arms placed in a wide-V configuration, over the upper body. The Ecolab Scope Pillow Warmer Drape is stretched over the retractor arms forming a barrier between the operative field and the surgeon and secured with snaps to the self-retaining retractor to maintain the tightness of the drape.\nAdditional self-retraining retractors that would suffice include a Bookwalter or Thompson retractor set; both can be used (Fig. 2 ). This is used as a protective shield for droplet precautions.\nFigure 2 Thompson retractor in place of Omni-Tract retractor set up in a similar fashion.\nFinally, the Buffalo Filter smoke evacuator tubing is connected to 2 heat moisture exchange (HME) filters and placed under the drape to provide further air filtration (Figs. 3 and 4 ). The reason for the multifilter system is to attempt maximum efficiency in filtering viral particles. According to the respective manufacturers, Buffalo Filter has 4 stages of filtration that reportedly ensure 99.999% efficiency, down to 0.1 to 0.2 microns, and HME filters provide bacterial and viral filtration exceeding 99.9%.\nFigure 3 Buffalo Filter smoke evacuator tubing connected to 2 heat moisture exchange filters and placed under the drape to provide further air filtration.\nFigure 4 Two heat moisture exchange filters connected in series to the Buffalo Filter smoke evacuator.\nThe operator and assistant will proceed with hands underneath the drape, allowing both the technician to pass instruments under the additional protection and the anesthesia team to access the airway (Fig. 5 ). A practice run was conducted to ensure smooth operation of the protocol, including the donning and doffing procedure and transferring of patients.\nFigure 5 Operator and assistant with hands underneath the clear sterile drape. The open access set-up allows both the technician to pass instruments under the additional protection and the anesthesia team to access the 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