Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit
- 1.1k Downloads
Early central venous catheter (CVC) insertion in Ebola virus disease (EVD) is a novel approach and has not previously been described. This report delineates the safety, feasibility and clinical implications of early CVC insertion as the optimum means of vascular access in patients with EVD, in the setting of a deployed military Ebola virus disease treatment unit in Sierra Leone.
In the gastrointestinal phase of EVD, a 7-French 20-cm triple-lumen CVC was inserted using aseptic technique. Data were collected prospectively on all cases to include baseline and subsequent blood test variables, insertion site and technique, and complications associated with CVC placement.
Twenty-three patients underwent CVC insertion as follows: subclavian, 21 (88 %); internal jugular, 2 (8 %); axillary, 1 (4 %). The mean duration of CVC placement was 5 days. There were no significant procedure-related adverse events. Despite coagulopathy being present in 75 % of cases, CVC insertion was safe, and there was only 1 case of significant catheter site bleeding. A total of 152 needle venepunctures were avoided owing to the presence of a CVC, a mean of 7 (±3.8) per case over the average stay.
The early use of CVCs in Ebola virus disease is safe, effective and facilitates patient care. It should be considered a feasible additional route of venous access, where physician expertise and resources allow.
KeywordsEbola virus disease Central venous catheter Volume replacement Circulatory access Resuscitation
The authors would like to acknowledge the support and hard work of all the nursing, biomedical science and support staff at the UK Defence Medical Service Ebola Virus Disease Treatment Unit, Kerry Town, Sierra Leone.
Conflicts of interest
The authors declare they have no conflicts of interest related to this paper.
- 1.Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, Soropogui B, Sow MS, Keita S, De CH, Tiffany A, Dominguez G, Loua M, Traore A, Kolie M, Malano ER, Heleze E, Bocquin A, Mely S, Raoul H, Caro V, Cadar D, Gabriel M, Pahlmann M, Tappe D, Schmidt-Chanasit J, Impouma B, Diallo AK, Formenty P, Van HM, Gunther S (2014) Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med 371:1418–1425CrossRefPubMedGoogle Scholar
- 13.Schieffelin JS, Shaffer JG, Goba A, Gbakie M, Gire SK, Colubri A, Sealfon RS, Kanneh L, Moigboi A, Momoh M, Fullah M, Moses LM, Brown BL, Andersen KG, Winnicki S, Schaffner SF, Park DJ, Yozwiak NL, Jiang PP, Kargbo D, Jalloh S, Fonnie M, Sinnah V, French I, Kovoma A, Kamara FK, Tucker V, Konuwa E, Sellu J, Mustapha I, Foday M, Yillah M, Kanneh F, Saffa S, Massally JL, Boisen ML, Branco LM, Vandi MA, Grant DS, Happi C, Gevao SM, Fletcher TE, Fowler RA, Bausch DG, Sabeti PC, Khan SH, Garry RF (2014) Clinical illness and outcomes in patients with Ebola in Sierra Leone. N Engl J Med 371:2092–2100CrossRefPubMedGoogle Scholar
- 16.Duffin C (2014) Ebola death toll rises in Africa with at least 14 nurses among the dead. Nurs Stand 28:9Google Scholar
- 18.Tomori O, Bertolli J, Rollin PE, Fleerackers Y, Guimard Y, De RA, Feldmann H, Burt F, Swanepoel R, Killian S, Khan AS, Tshioko K, Bwaka M, Ndambe R, Peters CJ, Ksiazek TG (1999) Serologic survey among hospital and health center workers during the Ebola hemorrhagic fever outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis 179(Suppl 1):S98–S101CrossRefPubMedGoogle Scholar
- 19.Brett-Major DM, Jacob ST, Jacquerioz FA, Risi GF, Fischer WA, Kato Y, Houlihan CF, Crozier I, Bosa HK, Lawler JV, Adachi T, Hurley SK, Berry LE, Carlson JC, Button TC, McClellan SL, Shea BJ, Kuniyoshi GG, Ferri M, Murthy SG, Petrosillo N, Lamontagne F, Porembka DT, Schieffelin J, Rubinson L, O’Dempsey T, Donovan SM, Bausch DG, Fowler RA, Fletcher TE (2014) Being ready to treat Ebola virus disease patients. Am J Trop Med Hyg 92:233–227Google Scholar
- 25.Hawkes N (2014) Ebola outbreak is a public health emergency of international concern. WHO Warns BMJ 349:5089Google Scholar
- 26.Rees PSC, Ardley C, Bailey M, Dickson S, Fletcher T, Hinsley D, Lamb L, Nicholson-Roberts T (2015) Op GRITROCK: the Royal Navy supports defence efforts to tackle Ebola. J R Nav Med Serv 100(3):228–230Google Scholar
- 29.Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De BD, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals. Intensive Care Med 38:192–209CrossRefPubMedCentralPubMedGoogle Scholar
- 36.Hockenhull JC, Dwan K, Boland A, Smith G, Bagust A, Dundar Y, Gamble C, McLeod C, Walley T, Dickson R (2008) The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation. Health Technol Assess 12:iii–xiiPubMedGoogle Scholar
- 37.Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De BD, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea. Intensive Care Med 38:542–556CrossRefPubMedCentralPubMedGoogle Scholar
- 38.Public Health Agency of Canada, Canadian Critical Care Society, Canadian Association of Emergency Physicians, The Association of Medical Microbiology and Infectious Diseases Canada (2014) Ebola clinical care guidelines. A guide for clinicians in Canada (interim report)Google Scholar
- 39.Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care 8:R204–R212CrossRefPubMedCentralPubMedGoogle Scholar
- 43.Expert Round Table on Ultrasound in ICU (2011) International expert statement on training standards for critical care ultrasonography. Intensive Care Med 37:1077–1083Google Scholar
- 47.Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De BD, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in Intensive Care Medicine 2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation. Intensive Care Med 38:345–358CrossRefPubMedCentralPubMedGoogle Scholar
- 50.O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S (2011) Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:1087–1099CrossRefPubMedCentralPubMedGoogle Scholar