Art line in burn patient?

[neuroride]

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Quick question, had a 38 yo guy last night brought in with a 37% burn from steam explosion, mainly localized to his arms and lower extremities. Intubated him and was asked to place art line. Had a escharotomy at bedside in the ER earlier. Looked for radial site but the escharotomy went to about 4 cm from the thenar eminence bilaterally. I could have placed the catheter in non burned skin but it would be tunneled into where the escharotomy began; could I have still done this without causing harm?

I ended up placing a right femoral art line where he had no dressing but possibly had a 1st degree burn given the redness. Any contradindications about doing this?

Thanks for any help/suggestions. This was my first burn patient encounter.

 

[urge]

What did your attending say?

 

[bogatyr]

You can put the art line anywhere. The biggest problem you wind up with is securing the catheter to burned or grafted skin. We usually try to put in a radial if we can get it, but any patient with any reasonable degree of burn ends up with a femoral a-line before too long. They seem to last longer than the radial lines.

 

[deleted9493]

Yeah, it's 'wherever you can get one' at our burn center. I used dorsalis pedis lines quite a bit in burns affecting hands/wrist.

 

[jennyboo]

Agree with "wherever you're lucky enough to get one" keeping in mind that these patients usually have 1) prolonged ICU course, 2) high infection risk, 3) high sepsis risk.

So if you're lucky to get a peripheral a-line I would take it -- though, more often than not after a few days or weeks they'll end up with a femoral a-line anyway. Since they're going to have the a-line for a long time, a long arterial catheter (as opposed to a little 20g angiocath) could be nice to have if you can put it in -- might last a day or so longer than the angiocath.

 

[neuroride]

Thanks for the input. I was the house officer with no other backup besides the ER. The pulmonologist who was consulted to manage the vent after my intubation was the one that agreed that we needed the art line (but didn't know the best place to put it).

I really didn't want to p*ss off the surgeon by placing an art line somewhere I shouldn't have. But, it is was the middle of the night and with no other input, I just went with what I thought was best for the patient.