Vascular Access in the Burn units

allnurses Guide · Oct 1, 2008

Hi there, we never used central lines always peripheral. If Periperal was difficult then IO even in adults even though it is a bit more difficult.

If we have no choice that to go through burnt tissue then we would do a cut down and secure with sutures covereing with burns dressing afterwards, however I hardly ever saw this done, we almost always manage a peripheral.

If all other options are impossible due to injury and access difficulties then and only then would central access be gained, but this would be for a short period only and as soon as peripheral access possible then central removed

land27 · Oct 12, 2008

I have been asked to collaborate with a research/educational project regarding vascular access in the burn patient. We aren't finding a whole lot of good data to back up current practices.
So, a few questions for you burn nurses:
-Does your unit routinely replace central lines?
-Have you used intraosseus access for initial fluid resusc. in adult patients?
-When you have no other choice but to go through damaged tissue for an IV,CVC or art line,how do you dress the site and secure the line?
-How does your central line infection rate run?
-Do you have any words of wisdom/tricks of the trade to share?
Thanks in advance.

I love Burns. Worked at OSU medical Center on the Burn Unit and ABLS certified. hope to give you a little feed back.

Generally our burn population in the unit always required central lines.

what kind of acuity you have makes a big difference too. I believe most central lines where being changed in surgery however and rarely at bedside unless was emergent line placement. I also know that we had central line access on most of our larger tsb burns prior to ever making it to the unit and they routinely had atleast an introducer placed even if a swan-ganz. catheter was not being used yet and sometime a additional TLC to accomodate for fluid recessitation/neuromuscular blockade/and any other gtts......I have seen lines through affected areas, generally sutured in. As far as drsg the site. used whatever we dressed the burn wound with. no tape to affected areas (wouldn't stay on anyway) used stretchy kerlex to wrap/secure aline. stretchy tube badages another option, twill tape used a lot.....all et-tubes used twill tape to secure them which made adjustung for facial edema easier. I don't recall our catheter infection rate.....

A few tricks to the traid if you don't already do them.

-Havetube feeds started on patient within 6 hours of the burn (not arrival to unit) through a postpyloric dht (nursing placed the DHT)......decreases ICU stays dramatically..

-Always maintain a miv rate for fluid recessitation and bolusing patient should be kept at a minimum. If a bolus was given we went up on miv as well. (bolusing patient's will turn 2nd burns into 3rd)

-pediatric ekg leads picked up better wavefrom with less artifact and stay on better.

**********VERY IMPORTANT...Saying AGAIN********************

good nutrition with very high caloric high protein intake through Gi track (preferd) is crucial to wound healing the critical to a burn patients recovery..............just as critical as proper fluid recessitation

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