Introduction: Intubation Shield
I am a physician and a maker. This is a simple intubation shield to (possibly) reduce exposure to infectious droplets during intubation. One of the highest risks for exposure to aerosolized material and respiratory droplets is during intubation. Standards of care are changing during the current COVID-19 pandemic so you should consult CDC and hospital guidelines for most up to date information. Availability of PPE is already limited to some locales. I saw an intubation box designed by Dr. Hsien Yung Lai (Thank you for the inspiration!) and COVID Box Project. I liked his design, and I think it would work really will for use with the smaller video laryngoscopes with integrated screens like King Vision. (I have no financial interest in any medical suppliers). We use a different style of video laryngoscope (Glidescope) with a separate screen mounted to a rolling cart. It may be technically difficult to pass the cables and handle through the smaller holes in Dr Hsien Yung Lai's box. If your facility uses the smaller laryngoscopes with integrated screen, I think the COVID box is probably superior in that it may offer better protection. (I'm definitely not an expert in flow dynamics, but it just looks more 'sealed'). This is an alternative design that may be better suited for laryngoscopes with cables and larger side mounted monitor. It also allows greater mobility for pre-oxygenation and during the procedure. It is relatively inexpensive and can be fabricated with common tools.
- Clear Acrylic Sheet 48 in x 36 in x 0.25 in
- Heat gun
- Jig saw
- Sand paper
- Scrap wood (for bend brake)
Step 1: Download PDF and Trace Pattern to Acrylic Sheet.
Download the design below. The Drawing PDF is 1:8 scale. There is also a template to print 1:4 scale. One of the greatest challenges of this project is to print the template. You may take to a print shop with a large format printer and ask them to enlarge. Alternatively, you can use a free program like adobe acrobat reader, open the template, click print icon, then select poster, and set Tile Scale to 400%. Then print template and tape ages together to create template.
Trace template outline on acrylic. I left the protective layer on the acrylic until I was finished. I've also attached a DXF file if you have access to a CNC machine or laser cutter.
Step 2: Cut Acrylic With Jig Saw.
I used a medium tooth blade (10/inch) on a jig saw to cut the acrylic. I was careful to stabilize the material during the cutting process to avoid cracking the acrylic. I also applied painter's tape to the bottom of the saw to avoid scratching the acrylic. I cut slowly and this seemed to work well. A band saw may be better if you have access to one. I then sanded to remove any sharp edges.
Step 3: Bending the Acrylic Sheet
I pulled back some of the protective layer and marked the areas for bending. I sandwiched the acrylic between two pieces of scrap wood and clamped. I used a heat gun to slowly warm the acrylic. It was actually very easy to bend once sufficiently heated. The trick is to be patient and not apply too much pressure. I held the material at the desired angle until cool.
Step 4: Use of Shield
Place the shield over head of bead with 'open' end toward patient feet. I stood at the head of the bed behind the shield and reached in from the sides holding the laryngoscope and ET tube in the usual fashion. There is still potential exposure from the side, so if possible additional staff should stand behind or out of the room. Obviously wear other recommended PPE (I have N95, + goggles + shield + gown + double gloves). PAPR may be a good addition. I have no evidence that this reduces exposure to infectious material. The advantage of this design is that it allows for a bit more mobility during the procedure and allows for cables associated with video laryngoscopes with separate monitors. The disadvantage is maybe a little more exposure than the COVID Box.
After use, we just wipe down with standard hospital cleaning wipes.
Here is a great reference and video of the COVID box with simulated cough and black light from NEJM.
Please suggest any improvements below in comments.