Log in | Register

Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit

P. S. C. Rees| L. E. M. Lamb| T. C. Nicholson-Roberts| C. N. Ardley| M. S. Bailey| D. E. Hinsley| T. E. Fletcher| S. J. Dickson
Seven-Day Profile Publication
Volume 41, Issue 5 / May , 2015

Pages 735 - 743

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

References

  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 371:1418–1425
    • View reference on publisher's website
    • View reference on PubMed
  2. Editorial (2014) Ebola: a call to action. Nat Med 20:967
    • View reference on publisher's website
  3. WHO Ebola Response Team (2014) Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med 371:1481–1495
    • View reference on publisher's website
  4. Colebunders R, Borchert M (2000) Ebola haemorrhagic fever—a review. J Infect 40:16–20
    • View reference on publisher's website
    • View reference on PubMed
  5. Wauquier N, Becquart P, Padilla C, Baize S, Leroy EM (2010) Human fatal zaire ebola virus infection is associated with an aberrant innate immunity and with massive lymphocyte apoptosis. PLoS Negl Trop Dis 4:e837
    • View reference on publisher's website
    • View reference on PubMed
  6. Gatherer D (2014) The 2014 Ebola virus disease outbreak in West Africa. J Gen Virol 95:1619–1624
    • View reference on publisher's website
    • View reference on PubMed
  7. Tattevin P, Durante-Mangoni E, Massaquoi M (2014) Does this patient have Ebola virus disease? Intensive Care Med 40:1738–1741
  8. Feldmann H, Geisbert TW (2011) Ebola haemorrhagic fever. Lancet 377:849–862
    • View reference on publisher's website
    • View reference on PubMed
  9. Nakayama E, Saijo M (2013) Animal models for Ebola and Marburg virus infections. Front Microbiol 4:267
    • View reference on publisher's website
    • View reference on PubMed
  10. Fletcher TE, Fowler RA, Beeching NJ (2014) Understanding organ dysfunction in Ebola virus disease. Intensive Care Med 40:1936–1939
  11. Yazdanpanah Y, Arribas JR, Malvy D (2015) Treatment of Ebola virus disease. Intensive Care Med 41:115–117
  12. Kortepeter MG, Bausch DG, Bray M (2011) Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis 204(Suppl 3):S810–S816
    • View reference on publisher's website
    • View reference on PubMed
  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 371:2092–2100
    • View reference on publisher's website
    • View reference on PubMed
  14. Hyde-Price C (2000) Under siege. An outbreak of the Ebola virus in Uganda has already taken its toll on nurses. Nurs Stand 15:20
    • View reference on PubMed
  15. Baron RC, McCormick JB, Zubeir OA (1983) Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread. Bull World Health Organ 61:997–1003
    • View reference on PubMed
  16. Duffin C (2014) Ebola death toll rises in Africa with at least 14 nurses among the dead. Nurs Stand 28:9
  17. Barry M, Traore FA, Sako FB, Kpamy DO, Bah EI, Poncin M, Keita S, Cisse M, Toure A (2014) Ebola outbreak in Conakry, Guinea: epidemiological, clinical, and outcome features. Med Mal Infect 44:491–494
    • View reference on publisher's website
    • View reference on PubMed
  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–S101
    • View reference on publisher's website
    • View reference on PubMed
  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 92:233–227
  20. Raabea VN, Borcherta M (2012) Infection control during filoviral hemorrhagic fever outbreaks. J Glob Infect Dis 4:69–74
    • View reference on publisher's website
    • View reference on PubMed
  21. Wichmann D, Schmiedel S, Kluge S (2015) Isolation in patients with Ebola virus disease. Intensive Care Med 41:511–513
  22. Pasquier P, Ficko C, Merens A, Dubost C (2015) Preparing an ICU room to welcome a critically ill patient with Ebola virus disease. Intensive Care Med 41:118–119
  23. Chan M (2014) Ebola virus disease in West Africa—no early end to the outbreak. N Engl J Med 371:1183–1185
    • View reference on publisher's website
    • View reference on PubMed
  24. Fauci AS (2014) Ebola—underscoring the global disparities in health care resources. N Engl J Med 371:1084–1086
    • View reference on publisher's website
    • View reference on PubMed
  25. Hawkes N (2014) Ebola outbreak is a public health emergency of international concern. WHO Warns BMJ 349:5089
  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):228–230
  27. Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de HG, Kluge S, Sow A, Renne T, Gunther S, Lohse AW, Addo MM, Schmiedel S (2014) A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med 371:2394–2401
    • View reference on publisher's website
    • View reference on PubMed
  28. Lyon GM, Mehta AK, Varkey JB, Brantly K, Plyler L, McElroy AK, Kraft CS, Towner JS, Spiropoulou C, Stroher U, Uyeki TM, Ribner BS (2014) Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med 371:2402–2409
    • View reference on publisher's website
    • View reference on PubMed
  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 38:192–209
  30. Joannidis M, Metnitz PG (2005) Epidemiology and natural history of acute renal failure in the ICU. Crit Care Clin 21:239–249
    • View reference on publisher's website
    • View reference on PubMed
  31. Legrand M, Bezemer R, Kandil A, Demirci C, Payen D, Ince C (2011) The role of renal hypoperfusion in development of renal microcirculatory dysfunction in endotoxemic rats. Intensive Care Med 37:1534–1542
  32. Boateng AA, Sriram K, Meguid MM, Crook M (2010) Refeeding syndrome: treatment considerations based on collective analysis of literature case reports. Nutrition 26:156–167
    • View reference on publisher's website
    • View reference on PubMed
  33. Marinella MA (2005) Refeeding syndrome and hypophosphatemia. J Intensive Care Med 20:155–159
    • View reference on publisher's website
    • View reference on PubMed
  34. West TE, von Saint Andre-von Arnim A (2014) Clinical presentation and management of severe ebola virus disease. Ann Am Thorac Soc 11:1341–1350
    • View reference on publisher's website
    • View reference on PubMed
  35. Lamontagne F, Clement C, Fletcher T, Jacob ST, Fischer WA, Fowler RA (2014) Doing today’s work superbly well–treating Ebola with current tools. N Engl J Med 371:1565–1566
    • View reference on publisher's website
    • View reference on PubMed
  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–xii
    • View reference on PubMed
  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 38:542–556
  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)
  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–R212
    • View reference on publisher's website
    • View reference on PubMed
  40. Volpicelli G (2011) Sonographic diagnosis of pneumothorax. Intensive Care Med 37:224–232
  41. Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D (2011) Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 37:1488–1493
  42. Cholley BP, Vieillard-Baron A, Mebazaa A (2006) Echocardiography in the ICU: time for widespread use! Intensive Care Med 32:9–10
  43. Expert Round Table on Ultrasound in ICU (2011) International expert statement on training standards for critical care ultrasonography. Intensive Care Med 37:1077–1083
  44. Hutchings SD, Rees PSC (2013) Trauma resuscitation using echocardiography in a deployed military intensive care unit. J Intensive Care Soc 14(2):120–125
    • View reference on publisher's website
  45. Simmons RS, Berdine GG, Seidenfeld JJ, Prihoda TJ, Harris GD, Smith JD, Gilbert TJ, Mota E, Johanson WG Jr (1987) Fluid balance and the adult respiratory distress syndrome. Am Rev Respir Dis 135:924–929
    • View reference on PubMed
  46. Kanji HD, McCallum J, Sirounis D, MacRedmond R, Moss R, Boyd JH (2014) Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care 29:700–705
    • View reference on publisher's website
    • View reference on PubMed
  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 38:345–358
  48. Shaw AD, Raghunathan K, Peyerl FW, Munson SH, Paluszkiewicz SM, Schermer CR (2014) Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med 40:1897–1905
  49. Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD (2015) Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg 102:24–36
    • View reference on publisher's website
    • View reference on PubMed
  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 52:1087–1099
    • View reference on publisher's website
    • View reference on PubMed
  51. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox MH (2007) Epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 65(Suppl 1):S1–S64
    • View reference on publisher's website
    • View reference on PubMed
  52. Kehoe A, Rees PSC (2006) Developments in pre-hospital care: is the specialty coming of age? J R Nav Med Serv 92:140–142
    • View reference on PubMed
  53. Moore CL (2014) Ultrasound first, second, and last for vascular access. J Ultrasound Med 33:1135–1142
    • View reference on publisher's website
    • View reference on PubMed
  54. O’Leary R, Ahmed SM, McLure H, Oram J, Mallick A, Bhambra B, Bodenham AR (2012) Ultrasound-guided infraclavicular axillary vein cannulation: a useful alternative to the internal jugular vein. Br J Anaesth 109:762–768
    • View reference on publisher's website
    • View reference on PubMed
  55. Meyer P, Cronier P, Rousseau H, Vicaut E, Choukroun G, Chergui K, Chevrel G, Maury E (2014) Difficult peripheral venous access: clinical evaluation of a catheter inserted with the Seldinger method under ultrasound guidance. J Crit Care 29:823–827
    • View reference on publisher's website
    • View reference on PubMed
  56. Egan G, Healy D, O’Neill H, Clarke-Moloney M, Grace PA, Walsh SR (2013) Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J 30:521–526
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement