1Yousef Yousef, 1Hiba Abdalla, 1Hala Al-Khaffaji, 1Delphine Qudreq, 1Ganesh Alluvada, 1Alison Edwards, 1Séan Matheiken, 1Davis Thomas, 1Maher Hamish
1Northampton General Hospital, Northampton, United Kingdom
Background:
Multiple bodies issued specialty advice during the UK’s first Covid-19 pandemic wave. We reviewed available guidance and produced a Covid-19-proofed pathway for local endovascular service provision, prior to availability of widespread testing.
Material(s) and Method(s):
1. Formulation of local treatment policy [Table 1].
2. Implementation of operational changes.
3. Overview of clinical outcomes.
4. Effectiveness of Covid-19 safety measures
Result(s):
1. Triage outcomes are shown in Table 1, column 6.
2. Implementation:
a. All non-essential IR suite visits redirected to phone/email.
b. Temperature screening at entrance.
c. All out-patients as Day-case.
d. In-patient cases ‘last on list’.
e. Face masks at all times by all individuals.
f. PHE guidance-for the respective week- and local IPC policy followed.
g. Staff numbers precluded staggered or segregated working rotas.
3. 185 procedures were performed for 146 patients with < 2% major complications and no immediate perioperative mortality or limb loss. Fig 1
4. 26 procedure for Fistuloplaties were performed.
5. Mortality < 2% within 30 days:
a. One patient tested COVID-19 +ve and deceased within 2 weeks while inpatient with uncertain source of infection.
b. One patient tested COVID-19 +ve and deceased within 26 days while inpatient with uncertain source of infection.
c. . One patient deceased within 27days while inpatient with no COVID-19 test.
6. No known outpatients and no involved staff tested Covid-19 positive within a fortnight of IR encounters.
Conclusion(s):
Our practice embodied consensus across four major guidance documents. Most advice (BSIR, VS, NHS) was generic and not condition specific. All specialty specific guidance omitted haemodialysis access. Our Covid-19 operational policy produced safe clinical outcomes.