The COVID-19 pandemic is posing challenges to health care systems across the world on a scale not experienced in generations. “Unprecedented” is frequently used to describe this crisis. Already, with over 400,000 confirmed domestic infections, hospital beds and health care resources are at a premium. Health care organizations are delaying elective procedures, preserving personal protective equipment (PPE), isolating infected patients and facing shortages of medications and blood products, while handling concerns about the viability of their workforce as they brace for a potential surge of patients. Interventional radiologists have the ability to transition several procedures to the bedside and perform early interventions on patients to preserve precious resources, and can effectively build stronger, collaborative relationships with other specialties.
As clinically focused specialists trained in image guidance, we have the ability to temporize urgent and emergent conditions. For instance, performing a bedside cholecystostomy under ultrasound guidance in lieu of a cholecystectomy preserves anesthesia and room resources while eliminating the risks of spread during transport. Similarly, paracenteses, thoracenteses, chest tube placements, biopsies, abscess drainages, nephrostomies, pseudoaneurysm thrombin injections, venous access, arterial access and IVC filters can all be performed with ultrasound guidance or with intravascular ultrasound guidance.
Taken together, much of the care that may be needed for COVID-19 patients can be performed at the bedside, thus preventing movement of these patients who would otherwise be in isolation. To facilitate bedside procedures, our unit has created “to go” bags encompassing everything necessary for a particular procedure in sterilizable clear backpacks, has stationed ultrasound machines in each COVID-19 unit for easy access, and has designated a team of procedural and support personnel to monitor donning and doffing, while minimizing contamination.
Aside from performing bedside procedures on COVID-19 patients, IRs can offer early and definitive intervention in patients that conserve blood products, decrease medication/anesthesia usage and facilitate earlier discharge. Ordinarily, selected gastrointestinal bleeds, solid-organ traumas, postpartum hemorrhage and other bleeding patients may be transfused and managed conservatively/expectantly. However, judiciously performing early angiography and embolization in patients likely to ultimately require it may reduce length of stay in the hospital. Additionally, other clinical services such as gastroenterology or urology may be unable to perform biliary drainage, urinary drainage or enteral procedures without the use of anesthesia. IR has the ability to perform similar percutaneous alternatives with fewer resources but equivalent results.
Adopting these strategies can help increase efficiency in the overall health care system, minimize infections across the hospital and preserve limited resources. With the agility, wide applicability and innovative spirit interwoven into the history of IR, we are poised to respond, contribute and be #HealthcareHeroes.
