The Mother of Invention Meets the Little Red Hen - The "Nat Mat"

From time to time the course of human events moves with such speed that governments, industry, science and society just can’t keep up.  Quick-thinking individuals may take the reins to move things along when the blur of circumstances defeats our institutions.  Alert colleague Natalie Kreitzer has stepped up to the plate to address a need in our practice in these troubled, chaotic times.  Dr. Kreitzer is the mother of two boys.  It is unknown whether this fact served as an inspiration for her also becoming a mother of invention, but I think it is safe to say that this role has given her more than a passing familiarity with oral and nasal secretions.

Read on…

COVID-19 is a respiratory illness spread in the general population by droplets, contact and fomites.  However, in our setting spread by aerosol must also be considered, particularly during high-risk procedures such as BVM ventilation and intubation.  While assiduous application of PPE including N-95 masks or PAPRs, face shields, goggles, gowns and scrubs is touted to be protective, health care workers performing these procedures have become infected.  While the causality between one and the other is not firmly established, this is a worrisome enough circumstance that one might wish for an additional layer of protection.

There are drapes that are intended to intercept exhaled aerosols from potentially infectious patients during extubation.  These drapes have also been adapted for use during intubation to accomplish this same goal.  So, Dr. Kreitzer sent me a video of such a use and asked, “Why are we not doing this?” I opined that cost and a procurement process that is not generally or generously described as nimble might be impediments.  Emulating the Little Red Hen of the children’s story, she replied, “Fine…then I’ll make it myself!”  Within a day she had ordered 400 feet of clear plastic sheeting and goaded me into doing a test with a dry cleaning bag.  The test was satisfyingly successful.  After repairing to my basement laboratory to consider modifications, a final design was conceived and executed.  Dr. Kreitzer rushed home and, violating a host of child-labor laws, had her boys manufacture a pile of these aerosol-intercepting drapes for our use in the Respiratory ED.

Ladies and Gentlemen, allow me to introduce the Nat Mat (also known as the Opt-De-Mist) - nine feet x four feet of superbly crafted plastic sheeting with three duct-tape reinforced access slits.  These will be available in a plastic sac appended to the intubation cart outside of Room 16 in the Respiratory ED beginning tomorrow morning.  Use is optional, but it can’t hurt and might just reduce the potential for viral spread during intubation.  The drape does not replace any of the currently recommended PPE - rather it augments it.

Instructions for use

Lay the plastic sheeting over the patient with the two vertical arm slits positioned at the upper corners of the mattress.  This should place the horizontal monitor slit approximately over the patient’s face.

Grab the King Vision in your left hand and insert your double-gloved, gowned arms through the arm slits.

Poke the monitor of the King Vision though the monitor slit - if you can adequately view the monitor through the plastic that is O.K., too.

Intubate, set the King Vision aside under the drape, confirm intubation by BVM/ETCO2 under the drape, run the ventilator tubing under the drape to the ETT adapter and ventilate.

Remove, roll up, and discard the drape.

On to the Video!

Dr. Otten suggested a perfectly acceptable alternative - first put your arms through the slits in the drape and carry the drape over your forearms, grab the King Vision, approach the head of the bed, then have your assistant lift the drape and spread it over the patient.

Props to Dr. K for having her finger on the pulse of our new world, and the initiative and inventiveness to make this happen quickly.       

Best,

I.C.C.