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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 102-103

Outpatient execution of vascular ultrasound diagnostic tests during the COVID-19 pandemic position paper of the Italian Society for Vascular Investigation


1 Angiology Unit, San Marco Hospital, Department of cardiovascular disease, University of Catania, Catania, Italy
2 Angiology Care Unit Villalba, Bologna, Italy
3 Vascular Centre, Nuova Villa Claudia, Rome, Italy
4 Vascular Metropolitan Surgery, Azienda USL di Bologna, Policlinico Sant'Orsola, Bologna, Italy
5 I.S.P.O, Villa delle rose, Florence, Italy
6 Vascular and Endovascular Surgery Unit, University Hospital, Siena, Italy
7 Division of Angiology, Department of Medicine -Verona University, Catanzaro, Italy
8 Angiology and Vascular Medicine Clinic, S. Anna Hospital, Catanzaro, Italy
9 International Vascular Foundation, Ferrara, Italy
10 Unit of Clinical Biochemistry, Section of Biochemistry and Biotechnology -Department of Biomolecular Sciences, University “Carlo Bo” of Urbino, Italy
11 Department of Vascular Surgery, University of Torino, Torino, Italy

Date of Submission22-Sep-2020
Date of Decision18-Oct-2020
Date of Acceptance29-Nov-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Dr. Pier Luigi Antignani
Vascular Centre, Nuova Villa Claudia, Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/VIT.VIT_27_20

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How to cite this article:
Failla G, Aluigi L, Antignani PL, Magnoni F, Baroncelli T, Benevento D, De Marchi S, Diaco E, Kontothanassis D, Mannello F, Varetto G, Costanzo L. Outpatient execution of vascular ultrasound diagnostic tests during the COVID-19 pandemic position paper of the Italian Society for Vascular Investigation. Vasc Invest Ther 2020;3:102-3

How to cite this URL:
Failla G, Aluigi L, Antignani PL, Magnoni F, Baroncelli T, Benevento D, De Marchi S, Diaco E, Kontothanassis D, Mannello F, Varetto G, Costanzo L. Outpatient execution of vascular ultrasound diagnostic tests during the COVID-19 pandemic position paper of the Italian Society for Vascular Investigation. Vasc Invest Ther [serial online] 2020 [cited 2021 Jan 27];3:102-3. Available from: https://www.vitonline.org/text.asp?2020/3/4/102/304841



In relation to the pandemic from COVID-19 declared on March 10, 2020, the rules of execution of vascular ultrasound examinations for professionals in the sector are defined.

It has been shown that viral infection is transmitted through close contact and in particular through droplets;[1] therefore, there is a high risk of transmission between the infected patient and the vascular doctor who performs the examination and vice versa.

This document aims to clarify the rules that regulate the execution of an ultrasound vascular examination and that allow to maintain a safety margin to minimize the possibility of virus transmission. Often, the echo color Doppler examination is performed in election, while in some cases, it takes urgent characteristics and is necessary to define a diagnosis (for example, in case of a deep vein thrombosis) or to establish a therapeutic strategy (in case of acute vascular diseases).

The indications on the management of COVID patients and on the use of personal protective equipment for health-care personnel are governed by specific national pathways and are also indicated by the WHO.[2] However, many ambulatory vascular specialists have requested the definition of a course dedicated to level I ultrasound examinations (ankle/brachial index) and level II (Eco-Duplex scanner).

The paucisymptomaticity or asymptomaticity of most of the virus carriers requires that the person who accesses the clinic be considered as a potential infected.[3]

Following these considerations, the Board of Directors of the Italian Society for Vascular Investigation has elaborated the following brief recommendations for the execution of the 1st and 2nd level ultrasound examinations:

  • The execution of serological tests, recently introduced for COVID SARS-2, is recommended for all health-care professionals involved in outpatient management
  • To ensure urgent and nondeferrable exams, while maintaining the possibility of refusing the specialist to carry out exams deemed inappropriate, according to his own judgment, limiting patient access to outpatient health areas
  • Before the examination, a telephone interview with the patient and/or the attending physician is recommended in which information is taken on the indications, on the indifference, on the general state of health of the subject that must be subjected to evaluation (feverish state, symptoms related to COVID-19 disease originating from a possible red zone)
  • The apparently non-COVID + patient must undergo body temperature measurement (threshold value 37.5°) before entering the clinic: the recent execution of negative nasopharyngeal swab does not constitute an absolute guarantee. In any case, it is recommended to set up a triage station before entering the clinic
  • Outpatient appointments must be spaced at least 30 min, when possible even more, recommending punctuality to users, so as to minimize the chances of crowding the waiting rooms and better allow compliance with the safety distances
  • The patient to be subjected to ultrasonography must be compulsorily provided with a certified surgical mask and disposable gloves to be worn in any case before entering the clinic. If the patient is not provided with it, the health facility must provide it before entering the clinic
  • The patient must not be accompanied by relatives within the ambulatory, except in the case of disabilities such that they cannot allow the examination without the presence of a family member; if necessary, family members must also wear a certified mask and gloves and must maintain the minimum safety distance from the operator
  • Furthermore, for the examination to be performed on the apparently non-COVID + patient, the performer should wear, if available, the FFP2 mask (as it is exposed to coughing for the patient positioned frontally and close to each other), the cover (also in nontissue fabric), and goggles or visor and double disposable gloves. As an alternative to the FFP2 mask, if not available, however, it is necessary to wear a certified surgical mask
  • Possibly, in a non-COVID area and compulsorily in a COVID area, the probe should be equipped with a probe cover
  • Before carrying out the examination, the operator should sanitize the hands with alcohol-based liquid as per the guidelines for checking the reference.


when the diagnostic test is concluded,it is necessary to throw the mask and the gloves and to sanitize the hands according to the modality indicated from Health Ministry.

The mask has to be changed every 3 h. Furthermore, the probes have to be sanitize following the rules indicated by the company.



 
  References Top

1.
Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA 2020;324:782-93.  Back to cited text no. 1
    
2.
Park SH. Personal protective equipment for healthcare workers during the COVID-19 pandemic. Infect Chemother 2020;52:165-82.  Back to cited text no. 2
    
3.
Costanzo L, Palumbo FP, Ardita G, Antignani PL, Arosio E, Failla G, et al. Coagulopathy, thromboembolic complications, and the use of heparin in COVID-19 pneumonia. J Vasc Surg Venous Lymphat Disord 2020;8:711-6.  Back to cited text no. 3
    




 

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