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LMA in Hep C patient?

Discussion in 'Anesthesiology' started by donkoski, May 12, 2008.

  1. donkoski

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    Would you put one in knowing that the pt has HCV and you might have to stick your fingers into their mouth to facilitate placement?

    I wouldn't. They get a tube every time.
     
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  3. huktonfonix

    huktonfonix board certified!
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    sure, why not. I cant remember the last time I've had to put my fingers in someones mouth to guide an LMA. About the only reason I do these days is to guide a stubborn OG/NG
     
  4. dhb

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    same here
    are you not going to put in an iv or a spinal?
     
  5. seinfeld

    seinfeld ASA Member
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    Universal precautions? Just because it not in their chart dont mean they dont have it.

    I too keep my hands out of the mouth except for that painful gastric tube.
     
  6. Planktonmd

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    An LMA is probably safer than having to remove the ETT at emergence and having the patient coughing and spraying you with his secretions.
    Just make sure you put the patient to sleep before you stick anything in his mouth (that applies to all patients even whiteout Hep C) ;)
     
  7. powermd

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    What a bunch of wussies. Double glove if you're that worried. Give 'em 20 mg of sux with induction if you think they might bite you. Or just an appropriate dose of prop. Consider a deep extubation. HCV is a fact of life in this job, protect yourself against every patient and don't change your routine just because you know someone has a bloodborne disease.
     
  8. donkoski

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    With older patients whose pressures can bottom out, it's a finer line to walk between asleep and awake when dosing the prop. Either way, you're sticking your fingers into something sharp where HCV lives. Sounds dangerous to me, but I guess I don't have the big fat balls of a "powermd."
     
  9. Gern Blansten

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    I would do it. If there jaw was "tight," I would wait and either breathe them down with more sevo or just give more propofol. I have also done the low dose sux which works just fine. I see this issue as one of the less risky things we do. The most needle sticks I have seen in others is with sewing in central lines.
    The other pet peeve of mine is the full sharps box and seeing people try to cram more sharps into it by physically pushing the contents down through that small opening. I have seen sharps spring back out of those boxes like pumas. If the box is full, get a new one. It is a small price to pay.
     
  10. Noyac

    Noyac ASA Member
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    If you don't want to use your fingers to place a stubborn LMA then pull the yankauer off the tubing, place the curved bulbus end of the yankauer on the back of the LMA with the tip against the tip of the LMA and guide it down.

    I try to never place my fingers in anyones mouth.
     
  11. huktonfonix

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    Its not that fine of a line if you give it fairly slowly and titrate to effect. I usually start off with 1 to 1.5 per kilo of prop and wait a bit on an older patient. Never understood why people insist on slamming home 2+ per kilo on every patient then thinking that postinduction hypotension is normal.
     
  12. donkoski

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    "If you don't want to use your fingers to place a stubborn LMA then pull the yankauer off the tubing, place the curved bulbus end of the yankauer on the back of the LMA with the tip against the tip of the LMA and guide it down.

    I try to never place my fingers in anyones mouth."

    This is a very good point re: the yankauer tip. I'll give it a try next time I use an LMA.
     
  13. izzygoer

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    i am not understanding what people mean by "putting your hand into the mouth"

    for an lma or intubation don't you scissor open the mouth with fingers agaqinst the teeth? i.e incisors? isnt that the most dangerous part?

    on more than one occaission with an attending breathing down my neck to go i have opened up a tight patient with my fingers.

    of course if i were 4-10 like every other resident i know i could stop and say he needs more relaxed more.

    anyway there have been times where i feel there teeth are ripping into my gloves sometimes
     
  14. Bertelman

    Bertelman Maverick!
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    The rate of transmission for HepC after a needle stick while wearing gloves is <5%. I think that's for an open-bore needle. Keith needles, etc. are lower.

    I would venture to guess that rate is closer to 0.1% for a gloved hand in the mouth of a contaminated Pt. unless there is obvious blood.
     
  15. coprolalia

    coprolalia Bored Certified
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    Man! That's a great tip, Noy. Thanks for passing along.

    -copro
     
  16. seinfeld

    seinfeld ASA Member
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    I have found that with good extension of the neck with the right hand on the occiput the mouth usually opens wide enough to get the blade in. I also use my pinky finger of the left hand when using a MAC 3 to push the lower lip out of the way. no matter how you do it you only need a cm or two to get the blade in. If the mouth doesnt open wide enough for lma with that then usually, in my expierence, they end up not being deep enough to start.
     
  17. jetproppilot

    jetproppilot Turboprop Driver
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    I humbly disagree.

    They'll get an LMA every time.

    Use a number four.

    Inflate it before you put it in.

    Make'm apneic with a huge dose of propofol.

    Use the proprietary JIGGLE TECHNIQUE that I and Zippy have described.

    No fingers in the mouth needed.

    And like Plank said, no risk of coughing etc at the end when you pull out an endotracheal tube.

    Just pull the mo-fo out at the end on an already spontaneously-breathing patient.

    Much better with an LMA IMHO.
     
  18. Arch Guillotti

    Arch Guillotti Senior Member
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    I would slap it in w/out too much worry.
     
  19. dhb

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    Cause you already have HSV...right? :laugh:
     
  20. Frank Rizzo

    Frank Rizzo Member
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    Propofol --> LMA --> next case

    I have at least one or two patients a week with Hep C. IF you practice safe precautions all the time, it doesn't matter. Stick the damn thing in and move on.
     
  21. goodoc

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    universal precautions, why the hell wouldn't you use an LMA?
     
  22. SleepIsGood

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    Use double gloves on your left hand (usually the hand that's 'scissoring').

    Also in a known HCV/HIV pt I alwys where eyeshields and try to wear those gowns the surgeons wear except turned the other way around.

    Of course...the name of the game is universal precautions. That means for everyone.
     
  23. dhb

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    I never scissor, if you have to do more than pull the chin down to open the mouth it means the patient isn't deep enough and will bite on your fingers/ LMA.
     
  24. mille125

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    i must say that i really dont understand your reasoning here
     

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