Creating a Biohazard Space for COVID19 Intubation: A covid intubation tent / box

Much like a biohazard hood; 2 principles are used

  • negative pressure (pulling bad stuff away from you)
  • directionality shielding (a clear shield protects your face while you work; and all other 3 sides are shielded)

In the most extreme situations a complete seal is formed. This doesn't work for emergent airways; we need something we can set on top of a patient in seconds; and get to work. It needs to be cheap, lightweight, and idiot proof.  We need visability. We need to protect everyone in the room; and give the intubator the best visable window and flexibility to work. 

 

Here is model one; the fastest and cheapest solution I could build in 5 minutes with stuff from a hardware store:

  • set of 6x 1/2" PVC pipes; cut to 23.5" length [$4]
  • 4x 3-way and curved standard fittings at junctions [$4]
  • 72x72" clear vinlyl sheet (AKA a shower curtain) [retail $2]

covid coronavirus intubation box tent

 

 

covid coronavirus intubation box tent

 I tried working under the slack of the front pieces; works; but particles preferentially go out into the user.

 

 

A few hours later; I have printed a few C clamps; that can snap on and off to hold the sheet to the frame  in tension. 

 

covid coronavirus intubation box tent

 

covid coronavirus intubation box tent

 

Next step will be arm holes; which ability to grip to the arm and allow some range while maintaining some element of seal. After that; I'll show you a vacuum port I've designed; where you can link up suction from the wall port in parallel to generate a negative pressure in the space.

 

 

 

 

covid coronavirus intubation box tent

 

 

I 3D printed a mold and cast silicone into it form a 2" hole in side a 6" reinforced sleeve; fits my arm (170lb 5'11" male) and my wife (100lb 5'2" female) with minimal tension.  When mated to the sheet adds minimal weight and allows for a user to insert/remove arms. Also; if you leave slack in the sheet facing the end use your can move around about 1 foot in all cardinal directions without issue.  I used ecoflex 35 extrafast by Smooth-On -- sets in 5 minutes. Adds a lot of weight but if you want to go overboard and make it airtight-ish here is how ya do it on the cheap.

 

 ***I ended up scrapping this silicone idea; adds time, cost and weight; while adding very little value***

VIDEO SHOWING ASSEMBLY/USE/DISASSEMBLY OF VERSION 1

 

 

I have updated the C clips to be easier to snap on and off. And I have decided against the silicone arm holes; rather cutting flaps as shown below. You can also perforate the plastic and then punch through when needed.

I've also stopped putting clips over the top; as its nice to have slack in the vertical direction during use. Watching a few other ICU and ED docs use it that was the most common wall struck during intubations (on an intentionally difficult maniquin).

Also, I bought a new/clean shower curtain and visability is MUCH improved (water stains from the old curtain made it blurry in the first version.  Target sells this one for $2! I bought a cart full.

 

covid coronavirus intubation tent box

 

covid coronavirus intubation tent box

 

covid coronavirus intubation tent box

 

 Today I experimented with overhand arms; 6" long on the top braces; adds neglicible weight; but changes how the sheet folds over. The main benefit is that you have more working room; no need for the sheet to go down to the mid-chest; in fact it enables chest compressions this way to shorten the arms along the pt's sides.

It also makes it easier for a 2nd or 3rd user to enter from the side. I cut quick circles and X's with a blade; took seconds, and works just as well as a careful loop. In a pinch it lets a second user in. 

covid coronavirus intubation box tent

covid coronavirus intubation box tent

 

covid coronavirus intubation box tent

 

covid coronavirus intubation box tent

 

covid coronavirus intubation box tent

 

I think it's worth adding the overhang; since the roof is what more user hit; and just choke up on the clips in the back of the unit. Make it more of a trapazoid.

Went and got more supplies; as we are gonna roll this out in our system at each site. I found cheaper parts too. Junctions are $0.65 and 10 feet PVC pipes were $1.69 for a 10 foot slat; I also got a PVC cutter for $15; worth every penny, cuts em like butter. I made 6 more units in 30 minutes; and got buckets to hold/clean em.

Files below

C-clip v3.27.20

https://drive.google.com/file/d/1wkQXHUYAqahx7baBKXvkhJEC0ibHXlYC/view?usp=sharing

C-Clip v3.24.20

https://drive.google.com/file/d/1DScsLzi-cxOXCx1ATNbP1d9A3DSfjpb0/view?usp=sharing

 

Mold ArmHole v3.24.20

https://drive.google.com/file/d/1cvv0qyzO6_QEono29neNoHUcsyHkLhVr/view?usp=sharing

 

 

 

***DISCLAIMER***

WARNING: Your Design Medical and it’s Owner Justin Henneman make no guarantee whatsoever that these devices will function perfectly (or even at all). These items were developed because people are dying & the health of our nation including our medical personal are at stake. Everything you do is at your own peril (welcome to life); but doing nothing to help is probably just as risky. Try not to sue me for helping once the dust settles; at least I can sleep at night knowing I tried.


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