Managing head and neck cancer patients with tracheostomy or laryngectomy during the COVID-19 pandemic
Kligerman, M.P., Vukkadala, N., Tsang, R., Sunwoo, J.B., Holsinger, F.C., Chan, J., Damrose, E.J., Kearney, A., & Starmer, H.M. (2020). PubMed.
Define any terms necessary:
Background:
Possible questions to ask your doctor:
Summary written by Avery Singson; Edited by Wendy Liang
February 8th, 2020
Define any terms necessary:
- Aerosolization: The formation of small particles that are dispersed in the air
- Droplet formation: Fluid droplets that can cause infection when they come into direct contact with someone
- Total laryngectomy (TL): surgical procedure in which the whole larynx or voice box is removed, and a stoma (opening) is made in the trachea (windpipe) in the front of the neck in which you will breathe through
Background:
- Data from the 2013 SARS-CoV-1 outbreak and initial data from the COVID-19 pandemic indicates that patients who have had recent tracheostomies or TL are likely at a higher risk of spreading the virus due to high rates of aerosolizing procedures and and droplet transmission from productive coughing.
- The following is a compilation of recommendations for the safe care of HNC patients with tracheostomies and TL in outpatient and inpatient settings based on the best available evidence.
- Creating and maintaining a closed ventilation circuit by using cuffed tracheostomy tubes, using inline suctioning, and avoiding nebulizer treatments may decrease the risk of aerosolization and droplet transmission among patients with confirmed or suspected COVID-19.
- Using heat moisture exchange units (HMEs) whenever tolerable may reduce aerosolization and droplet formation given the previous virus filtration rate of 99%.
- Tracheostomy and TL patients should pay special attention to hygiene -- taking extra care to minimize hand to tracheostoma contact in case their hands are contaminated with the virus, frequently cleaning electrolarynxes with disinfectant wipes, and regularly cleaning their pneumatic tubes or Taiwan tube artificial larynxes with hydrogen peroxide.
- Personal protective equipment (PPE) recommendations for patients include a surgical mask over their mouth, nose, and exposed tracheostoma. Clinicians are expected to wear an N95 or surgical mask, face shield, gown, and gloves depending on the procedure and exposure.
- If the patient is symptomatic, PUI, or positive for COVID-19:
- The patient must wear a mask over their nose and mouth and be treated using a closed ventilation circuit in conjunction with an inflated cuff.
- Healthcare workers must wear appropriate aerosolization PPE including an N95 mask, face shield, and a gown and gloves.
- If the patient is not symptomatic, PUI, or positive for COVID-19:
- An HME or tracheostomy cap should be placed over the patient’s tracheostomy site, trach collars should be avoided, and they should wear a surgical mask over the stoma if tolerable.
- Healthcare workers must wear aerosolization PPE including an N95 mask, face shield, and gown and gloves if manipulating the tracheostomy in any way. If the tracheostomy is not manipulated, droplet PPE including a surgical mask, face shield, and a gown and gloves must be worn.
- If the patient is symptomatic, PUI, or positive for COVID-19:
- If it is possible, the patient should delay their outpatient visit until they test negative and place a viral filter or tracheostomy cap over the end of their tracheostomy, wear a surgical mask over the site, and wear a mask over their nose and mouth.
- If delaying the visit is not possible, the patient should be sent to the emergency department or admitted to inpatient and be cared for by providers in full PPE.
- If the patient is not symptomatic, PUI, or positive for COVID-19:
- An HME or tracheostomy cap should be placed over the patient’s tracheostomy site and a surgical mask should be worn over the stoma if tolerable.
- Healthcare workers must wear aerosolization PPE including an N95 mask, face shield, and gown and gloves if manipulating the tracheostomy in any way. If the tracheostomy is not manipulated, droplet PPE including a surgical mask, face shield, and a gown and gloves must be worn.
Possible questions to ask your doctor:
- What precautions are you taking to ensure the minimization of transmission?
- How will the risk reduction strategies above affect my procedure/treatment?
- How can I minimize the risk of transmission in my everyday life?
- How will the vaccine affect the implementation/use of these measures?
Summary written by Avery Singson; Edited by Wendy Liang
February 8th, 2020