I found a decent article that summarizes some of the resuscitation protocols:
Fluid management in major burn injuries
But, spoiler alert, they all come down to urine output being the best indicator of fluid status and resuscitation status!
I think it's because the insensible losses with a burn are unlike any other injury. Monitoring the CO (cardiac output) is maybe helpful (and we can do that with the Vigileo...just need an A-line) but ultimately the patient's problem is not usually a cardiac problem. Their problems are vascular permeability and third-spacing that is unrecoverable, which leads to outright fluid loss. On top of that, the cellular destruction of the burned tissue can put a huge stress on the kidneys (electrolyte imbalances and rhabdomyolysis/myoglobinuria). So the best way to make sure the kidneys are really
being perfused is to measure the urine output.
The only other number we pay a lot of attention to on the Vigileo is the SVV (stroke volume variation)...as nurses, we usually use it as a way to convince a hesitant resident that YES, the patient probably still needs more fluid.
I certainly don't love femoral lines either, but the upper torso often is too burned for a line. If there's an unburned area of upper arm, we usually try to get a PICC placed after the first few days. We've definitely had patients with a femoral A-line and VasCath on one side and a CVC on the other. However, I can't think of one of these patients that has survived...they didn't die of CLABSI, but it's an indicator of the overall severity of the injury.