Phase of Care |
Considerations and Mitigation Strategies |
Preoperative
|
Decrease in viral shedding:
Testing available – De-isolation after two negative PCR tests in 24
hours
Testing unavailable – Consider delaying tracheostomy until 21 days
post-intubation
|
Perioperative
|
Location:
ICU preferable- minimizes transport
Negative pressure room
Surgical Team:
Minimize number of staff members during the procedure
Use of appropriate PPE (airborne and contact precautions)
Technical Considerations:
Patient paralysis to prevent coughing
Holding ventilation during tracheotomy until cuff inflated and circuit
reconnected
|
Postoperative
|
Droplet precautions during tracheostomy care
Use of closed, inline suctioning
Closed circuit with HEPA filter if on mechanical ventilatory support
HME when off ventilatory support
Delaying the first tracheostomy change to one month or after
de-isolation occurs for COVID-19 positive patients
|