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Title:
Vascular Access in Major Burn Patients: Development of a Decision-Making Algorithm for Device Selection and Management
Background: Major burn patients present a rare and complex clinical condition in which vascular access is essential for fluid resuscitation, drug administration and hemodynamic monitoring. However, central venous catheter (CVC) insertion on burned skin is associated with higher infectious, thrombotic and mechanical risk compared with intact skin.
Aim: To compare the main complications of CVCs in burned versus intact skin in adult major burn patients and to develop a practical decision-making algorithm supporting vascular device selection, insertion site, and management.
Methods: A narrative literature review was conducted (2010–present) using multiple biomedical databases (CINAHL, Cochrane, Joanna Briggs, Embase, PubMed and others). Studies on adult burn patients were included; pediatric, oncological cases and TBSA <20% were excluded. Additional guidance was collected from Italian Burn Centers and major institutional sources (EBA, SIUST, CDC, GAVeCeLT, INS).
Results: Burn patients show an increased risk of central line–associated bloodstream infection (CLABSI) and thrombotic events, with catheter dwell time, TBSA, age, comorbidities and insertion on burned or colonized skin identified as key risk factors. Femoral access is associated with higher infectious and thrombotic rates, whereas the internal jugular vein on intact skin is generally preferred when feasible. No studies directly compared CVCs placed on burned versus intact skin, and no specific international guidelines for vascular access in major burns were found.
Conclusions: In the absence of robust comparative data and dedicated guidelines, a stepwise decision-making algorithm was developed, integrating available evidence and expert consensus from Italian Burn Centers to provide objective criteria for CVC type, site selection, dwell time, and management in major burn patients. This tool aims to standardize vascular access practice, reduce complications, and support bedside decision-making in this high-risk population.