During the COVID19 pandemic, personal protective equipment (PPE) has been widely used
by clinicians and nurses, with a progressive lack of storage and recurring need for
supplies.
Considering the high number of asymptomatic patients, and the not-uncommon need for
endoscopic procedures for COVID-19-infected patients [1], it would be prudent to reduce as much as possible the exposure of healthcare workers
who operate at short physical distance from patients, especially in hospitals with
a high density of COVID-19 cases. Although stratification of preoperative patients
and proper training for the entire endoscopy staff are mandatory [2], clinicians have been forced to improvise and invent novel protective barriers in
order to reduce aerosol spread during high-risk procedures, such as tracheal intubation,
bronchoscopy or gastrointestinal endoscopy, which require level 3 personal protection
[3].
Here we present our endoscopic COVID Cube called the “C-Cube,” which has been specifically
designed with multiple entryways for direct management of the head-neck area, and
mechanically protects clinicians who have direct contact with the oral cavity during
invasive procedures ([Fig. 1]). The barrier is a mobile transparent protective box, which is composed of inexpensive
and easy-to-find materials (Plexiglas) and is completely washable. The box has two
elliptical ports in the posterior wall for the anesthesiologist’s hands, and one port
for endoscopic access on the right side ([Fig. 2]). In addition, the openings are covered by a single-use plastic layer with a central
longitudinal linear cut that allows physical access of the operator’s hands or instruments
(endoscope, laryngoscope, endotracheal tube), further reducing any possible leakage
of contaminated air.
Fig. 1 Illustration of the correct application of the “C-Cube” in the operative endoscopy
room. The shield covers the head of the patient and generates an “aerosol isolated
box” thanks to the direct airflow suction through the exit aspiration channel. Source:
Federico Amata.
Fig. 2 The structural characteristics of the “C-Cube”. a General three-dimensional overview (asterisk: exit aspiration channel). b The posterior wall. There is also a small aperture on the bottom of the left side
for the passage of monitoring cables or peripheral lines.
Other interesting homemade solutions have been described for either endoscopic [4] or anesthesiologic purposes [5], but a single system with practical access for both anesthesiologist and endoscopist
is preferable in our opinion. We have already tested the C-Cube for interventional
esophagogastroduodenoscopy, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography
under general anesthesia, with considerable efficacy ([Video 1]).
Video 1 Our personal experience of endoscopic procedures performed during the COVID-19 pandemic:
technical demonstration using the “C-Cube” endoscopic box.
Although this novel system lacks scientific validation, the barrier might provide
enhanced protection for all healthcare workers in the endoscopy room when combined
with appropriate PPE. In addition, the “C-Cube” may guarantee acceptable comfort during
therapeutic procedures, with low additional costs and easy reproducibility.
Endoscopy_UCTN_Code_TTT_1AU_2AC
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
