Hemodynamics in Burn Unit

  1. Hello,

    im wondering what various hemodynamics are transduced in different Burn units.

    CVP and A lines for sure.

    But do you also use Swans or PICCO or other CO monitoring?
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    About WestCoastSunRN, BSN, RN

    Joined: Nov '16; Posts: 326; Likes: 754
    from US
    Specialty: CVICU, MICU, Burn ICU


  3. by   marienm, RN, CCRN
    We get a lot of femoral CVCs and we often don't transduce a CVP. A-lines, yes, with a Phillips Vigileo monitor for the more unstable patients. (Some of our A-lines are pedal, so I question the validity, but the feeling is that it's better than nothing.) I've never used a Swan (our cardiac ICU uses them, but not us) and I just had to look up the PICCO. For reference: teaching hospital, adult Burn ICU but not an ABA burn center.
  4. by   WestCoastSunRN
    I'm at an ABA Burn unit, but we don't typically use CO measurement either. Apparently U/O is pretty much everything when it comes to resuscitation. As a former CVICU nurse I'd love to know the rationale for that. Seems like a swan or PICCO would give more detailed fluid balance info. But why wouldn't that be the case for a Burn? One could argue we don't want to be as invasive as a PA cath, but with PICCO you only need an A line and a CVC.
    And fem lines. Ugh. We have a lot of those, too. I really dislike fem lines due to increase for CLABSI.
  5. by   marienm, RN, CCRN
    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.
  6. by   WestCoastSunRN
    This is great, thank you! and yes, sometimes you have to go femoral as there simply isn't any other place to go....
  7. by   MDash
    I'm in an ABA Burn ICU in a teaching hospital. We use PiCCOs, A-lines, and CVPs. Our patients will often switch back and forth between PiCCOs and A-lines, depending on how intensively their fluid status needs to be monitored. Almost without exception, A-lines are radial; PiCCOs are axillary; CVCs are IJ or subclavian. I've never seen a pedal or femoral line, even with an upper body burn or weepy SJS. We use betadine-soaked gauze if we can't get a dressing to stick.
  8. by   Cdinern
    For the longest time we've gone by U/O and then eventually use CVP. As of recently however, we have been using PiCCO. Certain attendings love it. It's a pain in the butt to gather all the supplies as we don't stock them everywhere and it's a scavenger hunt to find the catheters, transducers, etc. but once it's set up, I do find that it's helpful in directions f our fluid goals.