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A Survey of Invasive Catheter Practices in U.S. Burn Centers

Sheridan, Robert L. MD*║; Neely, Alice N. PhD; Castillo, Mayra A. RN, BS; Shankowsky, Heather A. RN§; Fagan, Shawn P. MD*║; Chung, Kevin K. MD; Weber, Joan M. RN, BSN, CIC**

doi: 10.1097/BCR.0b013e318254d4ab
Original Articles

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.

From the *Shriners Hospitals for Children ®—Boston, Massachusetts Shriners Hospitals for Children ®—Cincinnati, Ohio US Army Institute of Surgical Research, Fort Sam Houston, Texas §Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, Canada; and Massachusetts General Hospital, Boston

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense.

Address correspondence to Joan M. Weber, RN, BSN, CIC, Shriners Hospitals for Children, 51 Blossom St, Boston, Massachusetts 02114.

© 2012 The American Burn Association