A Survey of Invasive Catheter Practices in U.S. Burn Centers
ABSTRACT Burn-specific guidelines for optimal catheter rotation, catheter type, insertion methods, and catheter site care do not exist, and practices vary widely from one burn unit to another. The purpose of this study was to define current practices and identify areas of practice variation for future clinical investigation. An online survey was sent to the directors of 123 U.S. burn centers. The survey consisted of 23 questions related to specific practices in placement and maintenance of central venous catheters (CVCs), arterial catheters, and peripherally inserted central catheters (PICCs). The overall response rate was 36%; response rate from verified centers was 52%. Geographic representation was wide. CVC and arterial catheter replacement varied from every 3 days (24% of sites) to only for overt infection (24% of sites); 23% of sites did not use the femoral position for CVC placement. Nearly 60% of units used some kind of antiseptic catheter. Physicians inserted the majority of catheters, and 22% of sites used nonphysicians for at least some insertions. Ultrasound was routinely used by less than 50% of units. A wide variety of post-insertion dressing protocols were followed. PICCs were used in some critically injured patients in 37% of units; the majority of these users did not rotate PICCs. Thus, it can be surmised that wide practice variation exists among burn centers with regard to insertion and maintenance of invasive catheters. Areas with particular variability that would be appropriate targets of clinical investigation are line rotation protocols, catheter site care protocols, and use of PICCs in acute burns.
Article: The year in burns 2012[Show abstract] [Hide abstract]
ABSTRACT: Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details.Burns: journal of the International Society for Burn Injuries 11/2013; 39(8). DOI:10.1016/j.burns.2013.11.001 · 1.84 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The aim of the study was to conduct a systematic review to identify and appraise the evidence on possible association of the site of venous catheter insertion in burn patients and an increased occurrence of catheter-related infection. Searches were performed in MEDLINE, LILACS, CINAHL, EMBASE, Web of Science and The Cochrane Library. Nine studies were selected for the review; four of them mentioned, directly or indirectly, an association between catheter-related infection and the insertion of the catheter either in the burn wound or in surrounding area, and five studies investigated the occurrence of infection related to both the catheter and the anatomical sites of catheter insertion. Higher infection rates occurred when the catheters were inserted directly in the burn wound or near the wound (level of evidence IV) or in the femoral vein (level of evidence IV). No significant differences in infection occurrence rates were observed between central catheters and peripherally inserted central catheter (level of evidence IV). Further investigations for techniques and types of coverage of venous catheter insertion dressings are important for preventing infection in burn patients. Also, new technologies for venous access must be evaluated.Burns: journal of the International Society for Burn Injuries 11/2013; 40(3). DOI:10.1016/j.burns.2013.10.026 · 1.84 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Existing practice guidelines designed to minimize invasive catheter infections and insertion-related complications in general intensive care unit patients are difficult to apply to the burn population. Burn-specific guidelines for optimal frequency for catheter exchange do not exist, and great variation exists among institutions. Previously, the practice was to follow a new site insertion at 48 hours by an exchange over a guidewire, which was followed 48 hours later by a second guidewire exchange (48h group). As a performance improvement initiative, the authors attempted to determine whether there would be any advantage or disadvantage to extending these intervals to 72 hours (72h). All patients with centrally placed intravascular catheters from October 2007 to August 2008 were included in the 48h group, and all patients with catheters placed from September 2008 to December 2009 comprised the 72h group. Catheter infection rates were determined using the National Healthcare Safety Network definition for central line-associated bloodstream infections (CLABSIs) and calculated as CLABSIs/1000 catheter days. The two groups were not significantly different for age, sex, cause of burn, total burn size, or percent third-degree burn. There were 3.1 CLABSIs/1000 catheter days for the 48h group and 2.8 CLABSIs/1000 catheter days for the 72h group (NS). The authors conclude that increasing the central catheter change interval from 48 to 72 hours did not result in any increase in their CLABSI rate. Implementation of this change in practice is expected to decrease supply costs by $28,000 annually in addition to reducing clinical support services needed to perform these procedures.Journal of burn care & research: official publication of the American Burn Association 01/2014; DOI:10.1097/BCR.0000000000000020 · 1.55 Impact Factor