Division of Pulmonary & Critical Care Medicine

As of 3/16/2020

1. Due to the significant and dramatic change in the environment regarding COVID-19, all Bronchoscopy and IP procedures were reviewed for the next 2 weeks. Each case was classified and in cases of Non-Urgent and Routine, patients were contacted, and intervention discussed with them.
2. Bronchoscopic procedure Classification and Prioritization standardized.

3. ICU Bronchoscopy
   1. No procedures should be performed if possible. Despite antiviral protection in intubated/mechanically ventilated patients, bronchoscopy opens closed system exposing all in room to possible respiratory pathogens. If a procedure is referred to IP the following will be followed universally:
   2. For the next three weeks an IP staff has been designated as inpatient IP Inpatient Procedure Staff. They will be responsible for evaluating and performing all inpatient procedures.
   3. All patients in the ICU will have their bronchoscopy in the ICU, even in situations that that they would have been transferred to the bronchoscopy suite in the past.
   4. All cases referred to IP will be reviewed by the inpatient IP Inpatient Procedure Staff. The IP Staff will speak directly to the Attending Staff should there be questions regarding the necessity or scope of the procedure.
   5. As a rule, PUI Cases will not be bronched unless there is a life-threatening situation in which the bronchoscopy has the potential to impact it.
   6. As a rule, COVID-19 positive Cases will not be bronched unless there is a life-threatening situation in which the bronchoscopy has the potential to impact it.
   7. COVID-19 negative patient cases will be reviewed by the IP Inpatient Procedure Staff.
   8. All bronchoscopies performed will use Airborne Plus precautions: N95 mask, Face shield, Head covering, moisture barrier gown, and gloves. Proper removal of PPEs will be followed.
   9. All bronchoscopies, unless a life-threatening airway issue, will be performed using disposable bronchoscopes.
   10. For more information regarding proper removal of PPEs refer to: https://youtu.be/bG6zISnenPg
4. Thoracentesis will be performed at bedside by the IP Inpatient Procedure Staff
   1. Central Supply (161414) must be called to order the thoracentesis tray.
   2. The PeopleSoft number for thoracentesis kit is 12037
   3. You will need a room number. They will send it to bedside
   4. This usually takes 1 hour.
5. IP staff will meet on Monday and Thursday afternoons at 2pm to discuss all scheduled or proposed procedures.
6. IP staff will communicate as a group twice daily by text to address any issues that may arise in the preceding 12 hours, to ensure coverage and ensure that no-one has demonstrated any symptoms.

AABIP/WABIP COVID-19 Statement

• Because it is an aerosol generating procedure that poses substantial risk to patients and staff, bronchoscopy should have an extremely limited role in diagnosis of COVID-19 and only be considered in intubated patients if upper respiratory samples are negative and other diagnosis is considered that would significantly change clinical management.
• Alternative respiratory specimen collection in the intubated patient can include tracheal aspirates and non-bronchoscopic alveolar lavage (N-BAL).
• If bronchoscopy is being performed for COVID 19 sample collection, a minimum of 2- 3 ml of specimen into a sterile, leak proof container for specimen collection is recommended. (4)