Contents
Aims
The aim of this page is to provide links to reliable sources of information and to our local unit protocols. Given that advice is rapidly-changing, we have linked to original sources rather than replicating advice here. We have separate patient information about COVID-19
Unit Protocols – start here
Almost all of the relevant guidance can be found here (much of it specific for NHS Lothian).
- Intranet pages and guidance documents (only accessible within NHS Lothian)
- Anticipatory care planning (only accessible within NHS Lothian)
- Lothian & Borders COVID19 Haemodialysis Guidance
- Lothian & Borders COVID19 Information for Dialysis Patients
- Lothian “COVID Zone” induction pack
- changes to the Renal & Transplant service (e.g. how to arrange outpatient blood tests during the COVID-19 pandemic)
External links
Core guidance
- HPS / PHE guidance on PPE
- Health Protection Scotland guidance – Covid19 homepage
- Health Protection Scotland – guidance for health professionals in secondary care
- NHS Inform – information for health professionals
- WHO guidance on clinical care
- NICE guidance on decisions around critical care
- BMA guidance on ethical issues
- Public Health England – guidance for the public
- Public Health England – guidance for health professionals
- Public Health England – guidance on PPE / infection control
- NHS England – guidance for clinicians in secondary care
- CMO Scotland letter on death certification (24th March 2020)
Society guidelines
- Resus Council statement on CPR and infographic and revised algorithm
- Renal Association guidance for health professionals
- Renal Association / BTS guidelines for management of transplant-recipients with Covid-19
- Renal Association guidelines for management of patients on immunosuppression for kidney disease (non-transplant)
- RA guidelines for decision-making in ESKD
- NICE guidelines on dialysis service delivery
- RCOG guidelines on pregnancy
Education & further information
- RCPE weekly evening updates
- NHS Lothian Medical Education pages
- NHS Lothian “upskilling” sessions on Zoom
- NHS Education for Scotland TURAS pages
- UoE / RCPE Critical Care course on FutureLearn
- online training for enrolling patients in the RECOVERY trial
- Internet Book of Critical Care – critical care textbook
- Coronavirus Tech Handbook – collaborative document with links to many other sources
- NephJC pages – an ever-expanding resource with renal-specific information on Covid-19 and transplant, dialysis, AKI, ACEi / ARBs etc.
What to tell patients
See our page on patient information about COVID-19 and the Kidney Care UK site. The most vulnerable patients are being advised to adopt “shielding” measures. The Renal Association have published guidance on who this should apply to.
Treatment of COVID-19
General principles
Early anticipatory care planning is vital for ALL patients. Complete NHS Lothian proforma. This should be completed on Trak [EPR > Overview / Progress > Hospital ACP (Cov 19)], but a paper version is also available.
The management of patients with COVID-19 is the same as for any viral pneumonia / pneumonitis. Follow the usual principles of good supportive care. Avoid excessive fluid resuscitation. Avoid nebulisers, steroids and antibiotics unless there is an alternative indication for their use (e.g. asthma or superadded bacterial infection).
Evidence base
The only specific therapies with RCT evidence of efficacy in (some patients) with Covid-19 are remdesivir and dexamethasone. Other therapies are being assessed in the RECOVERY trial. There are no high-quality data to suggest that we should be avoiding any particular class of medication. Most expert guidance advises that patients who currently take an ACEi or ARB continue to do so. Current UK advice is that there is no strong evidence that NSAIDs are detrimental in this context but that given a degree of uncertainty, paracetamol should be used first-line.
Acknowledgements: The author of this page was Rob Hunter. It was first published 17 March 2020. The date it was last modified is shown in the footer.
