Department of Dermatology, Korea University College of Medicine, Seoul, Korea.
Department of Anatomy, Korea University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2022 Mar 21;37(11):e88. doi: 10.3346/jkms.2022.37.e88.
Nasopharyngeal swabs have been widely to prevent the spread of coronavirus disease 2019 (COVID-19). Nasopharyngeal COVID-19 testing is a generally safe and well-tolerated procedure, but numerous complications have been reported in the media. Therefore, the present study aimed to review and document adverse events and suggest procedural references to minimize preventable but often underestimated risks. A total of 27 articles were selected for the review of 842 related documents in PubMed, Embase, and KoreaMed. The complications related to nasopharyngeal COVID-19 testing were reported to be rarely happened, ranging from 0.0012 to 0.026%. Frequently documented adverse events were retained swabs, epistaxis, and cerebrospinal fluid leakage, often associated with high-risk factors, including severe septal deviations, pre-existing skull base defects, and previous sinus or transsphenoidal pituitary surgery. Appropriate techniques based on sufficient anatomical knowledge are mandatory for clinicians to perform nasopharyngeal COVID-19 testing. The nasal floor can be predicted by the line between the nostril and external ear canal. For safe testing, the angle of swab insertion in the nasal passage should remain within 30° of the nasal floor. The swab was gently inserted along the nasal septum just above the nasal floor to the nasopharynx and remained on the nasopharynx for several seconds before removal. Forceful insertion should be attempted, and alternative examinations should be considered, especially in vulnerable patients. In conclusion, patients and clinicians should be aware of rare but possible complications and associated high-risk factors. The suggested procedural pearls enable more comfortable and safe nasopharyngeal COVID-19 testing for both clinicians and patients.
咽拭子已被广泛用于预防 2019 年冠状病毒病（COVID-19）的传播。鼻咽 COVID-19 检测是一种通常安全且耐受良好的程序，但媒体报道了许多并发症。因此，本研究旨在回顾和记录不良事件，并提出程序参考意见，以最大程度地减少可预防但经常被低估的风险。总共选择了 27 篇文章，以审查在 PubMed、Embase 和 KoreaMed 中与 842 篇相关文献的 842 篇相关文献。与鼻咽 COVID-19 检测相关的并发症报告发生率很低，范围从 0.0012 到 0.026%。经常记录的不良事件包括滞留拭子、鼻出血和脑脊液漏，这些通常与严重鼻中隔偏曲、先前存在颅底缺陷以及先前鼻窦或经蝶垂体手术等高危因素有关。基于充分的解剖知识的适当技术是临床医生进行鼻咽 COVID-19 检测所必需的。鼻底可以通过鼻孔和外耳道之间的线来预测。为了安全检测，拭子插入鼻腔的角度应保持在鼻底 30°以内。将拭子轻轻沿着鼻中隔插入，刚好位于鼻底上方，到达鼻咽部，并在取出前在鼻咽部停留几秒钟。不应强行插入，应考虑替代检查，尤其是在脆弱患者中。总之，患者和临床医生应该意识到罕见但可能发生的并发症和相关的高危因素。建议的程序要点使临床医生和患者都能更舒适、更安全地进行鼻咽 COVID-19 检测。
