A common reason patients are admitted to hospital is due to infection. Sometimes, there is a clear source of the infection, for example a chest infection, also known as pneumonia or a urinary tract infection, also known as a water infection. In other cases, it may be less obvious. In both cases, the initial management of these conditions will include antibiotics and fluid therapy.
Sometimes, with their infection, a patient may present or become more significantly unwell, with a condition known as sepsis. Sepsis occurs when an infection triggers a patients’ immune system to go into overdrive and begin causing damage to their own body. The main consequence of this is a fall in blood pressure. If the blood pressure is then low, the patients’ organs don’t receive enough blood supply, meaning they don’t receive the nutrients they need to function well, and they can begin to fail.
Sometimes, septic patients respond well to fluid therapy, but in other cases they may not. It is these patients who may be admitted to critical care, where they can receive more intense monitoring and importantly where specific treatments and medications can be administered that are unsafe to do so, on a general ward.
This is an arterial line. It looks similar to a cannula, or drip, which you may well have seen or even had yourself for any previous medical treatments. It goes in an artery, and helps us measure your blood pressure very accurately, more so than the normal blood pressure cuff. It also allows us to take blood tests regularly.
These are usually placed in an artery at the wrist, but may also be placed in the elbow, the groin, or the foot.
Most patients who are admitted to critical care will require an arterial line, whether they have sepsis or many other conditions, so this is a common thing to see.
This is a central line. It is effectively the same device as the cannula, or drip, which you will have likely seen before. The differences are that the central line has multiple lumens or tubes within it, so we can use it for multiple medications, and the tip of it sits near the heart. This is important for the delivery of certain medications, such as the strong medications we may use to support blood pressure.
These are usually placed in the neck or the groin.
Many, but not all patients admitted to critical care will require a central line, so again, this is fairly common to see.
Due to the low blood pressure state, it is relatively common for patients with sepsis to develop what is medically referred to as an acute kidney injury, sometimes referred to as acute kidney failure. The initial treatment for this, like sepsis, really focusses on fluids, however in some case these patients may require support that we call renal replacement therapy, a bit like dialysis, and also commonly referred to as ‘filtration’. Please see the associated video for a more detailed explanation regarding this.