Attached is a link to an article in the New York Times "Ebola Doctors Are Divided on IV Therapy in Africa" surrounding the use of IV rehydration. There are valid points being made by both sides in this debate.
For those without access to the article, in brief, it discusses that respected clinicians differ in their approach to rehydration and use of IVs in those with Ebola.
Some advocate for IV therapy or even intraosseous infusion with aggressive rehydration and electrolyte replacement, while others take a more conservative approach based on long experience, familarity with the limitations of the care environment, and concern over the increased risk of complications and exposure to staff.
Although some facilities that use IV therapy can boast lower than average mortality rates, some that use more a more conservative approach also have low mortality rates.
The differing success rates with IV therapy could be a function of many factors , such as those mentioned in the article, but I wanted to highlight that varying levels of adherence to standards of infection control, IV line care, and IV protocols between facilities may further complicate matters.
What other issues might be at play - is IV therapy the better way to rehydrate and treat Ebola or is it the quality of the therapy which matters more? The debate is ongoing.
Here are a few observations from what I saw or was told was being done as regular practice ( vs written protocols) at facilities run by a number of differing groups ; These items are being brought up to add to the discussion, and are not intended to advocate for one protocol over another, as it is a very complex issue.
Flushing the line: Cannulas were not necessarily being flushed on a daily basis so at the point that the patient might require IV hydration, an IV that was first inserted days before, upon admission, was no longer patent and had to be reinserted requiring another stick.
Infection control for IVs: IV hubs were not necessarily being cleaned prior to the IV being accessed. Since bags were only hung when staff were in the ETU, the lines might be accessed a few times a day, each time presenting an opportunity to introduce microorganisms into an already compromised patient.
Phlebitis, infiltration, extravasation: There were patients that evidenced phlebitis,extravasation, or infiltration. The changes at or above the site may have been due to general irritation,catheter movement, bacterial infection at the site , changes in endothelial tissue as a complication of Ebola , thrombosis, or all of the above but regardless, it made for painful and problematic IVs.
Pressure infusion: Pressure infusion would be used to shorten infusion times due to staffing time limits in the ETU . While fluid bolus may not be an issue in general, Ebola related endothelial changes might place patients more at risk for IV complications from pressure infusion.
Link leads to: http://www.nytimes.com/2015/01/02/health/ebola-doctors-are-divided-on-iv-therapy-in-africa.html?_r=0