Wednesday 17th June 2020
Figures for 16th June
UK COVID Deaths 233 / Total 41,969
James Cook Hospital – Total COVID deaths – 250
All COVID cases within South Tees Hospitals Trust – 13
James Cook Critical Care COVID cases – 2 / 2 ventilated
James Cook Critical Care non-COVID cases – 38 / 21 ventilated
I am back working on one of the ICUs today. We have admitted another COVID patient in the past couple of days to another of our isolation rooms but numbers of COVID patients within the trust have continued to fall.
Most of the patients remain stable and the ward round passes uneventfully. We had one patient who needed a new central venous line. A central venous line or catheter is a large, long, intravenous cannula that is placed into one of the large ‘central’ veins in the body. These are usually the neck (the internal jugular vein), the chest (the subclavian vein) or the groin (the femoral vein). They are used in Critical Care for the administration of drugs that would cause harm to a smaller, peripheral vein or for fluid resuscitation. They can also be used to monitor central venous pressure - the pressure in the great veins entering the heart. This gives information on how well resuscitated the patient is and how well the heart is working. Dialysis lines are similar, larger diameter catheters that are used to take blood back and forth to a dialysis machine.
Insertion of these catheters is usually straightforward if you are experienced but they can be associated with a few complications such as a collapsed lung if the needle used to insert a neck or chest line contacts the pleural lining of the lung. In order to minimise such complications, ultrasound probes are used to visualise the central vein during insertion and ensure correct placement of the catheter.
Older Consultants like me grew up inserting these catheters without ultrasound. We would use what’s called a ‘landmark technique’, where the catheters are inserted using the patient’s anatomy to guide placement. Whilst not used very often nowadays, these techniques are still safe in experienced hands and can be very useful in a hurry when you are faced with a very sick patient and little time to give vital drugs, blood or resuscitation fluids. I believe it’s something that every Intensive Care trainee should learn. There are always times when a low-tech technique can save the day.
Kay, one of our senior registrars had revealed that she had never inserted a subclavian line using the landmark technique so I decided that it was time that she learnt. Despite some initial misgivings on her part, I instructed her and everything went smoothly. Indeed, she made the whole procedure look very slick.
In the afternoon I had my COVID-19 antibody test. This involved visiting the Clinical Infection department for a blood test. These tests are available to all hospital staff and will determine whether they have had COVID-19 and mounted an antibody response. To be honest I will be surprised if I haven’t had it as a significant number of my team became unwell and tested positive for COVID-19 at one point in April when we were all working in fairly close proximity. If I did catch it then I was asymptomatic as I didn’t develop any symptoms. It will take between 1-2 weeks before I know the result.
As I was getting ready to leave tonight we had a new admission arrive in ICU. It was a gentleman who had developed alcohol-related liver failure over the past few days and was now extremely unwell. It is highly likely that he will need intubating and ventilating later this evening.
Alcohol sales have increased by up to 290% during lockdown according to one study and there is evidence that Britain’s 600,000 problem-drinkers are drinking significantly more than before the pandemic. Alcohol Change UK has seen a five-fold increase in the numbers of people accessing the ‘Get Help Now’ section of its website. Of course, it’s not just problem drinkers who are drinking more. My own alcohol intake has increased over the past two months although it is far from ‘problematic’ – but I would say that, wouldn’t I? I am certainly drinking less now that things are calmer at work which is no bad thing.
We are seeing more and more alcohol-related health problems and there are many of us who fear that, whether or not we see a second wave of COVID patients, we will invariably see a ‘third wave’ of alcohol-driven intensive care admissions.