title: Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ, Birmingham, UK, drpscrees@aol.com.
authors.forename: P S C
authors.initials: PS
authors.lastname: Rees
authors.forename: L E M
authors.initials: LE
authors.lastname: Lamb
authors.forename: T C
authors.initials: TC
authors.lastname: Nicholson-Roberts
authors.forename: C N
authors.initials: CN
authors.lastname: Ardley
authors.forename: M S
authors.initials: MS
authors.lastname: Bailey
authors.forename: D E
authors.initials: DE
authors.lastname: Hinsley
authors.forename: T E
authors.initials: TE
authors.lastname: Fletcher
authors.forename: S J
authors.initials: SJ
authors.lastname: Dickson
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D061214:Patient Safety; D012807:Sierra Leone; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000998:Antiviral Agents