burn sites and IV's

[brock8024]

I would think that you could find a place to start an IV other than the burned area. I work in a burn center and yet seen a burn patient that did not have a site that you could not start a IV in. I mean lets look at this realistically. We as humans have two hands, arms, legs, feet, and a neck. All these areas have multiple areas that you can start an IV. Well the neck may only have one spot on each side. But if you think about it how many burns have you seen that had both feet, hands, arms to where you could not get a IV.

Another thing is that most burns can convert from 1st to 2nd and from 2nd to 3rd. As far as the pain things is concerned if I am burned and you do not start an IV to controll my pain and or to induce intubation I am going to be a little pissed. I know we try not to hurt our patients but sometimes we have to to help them.

I do not think that you will ever come across a Pt that has been burned so bad that you can not start an IV in a hand, arm , foot or leg.

[scottymedic]

I had an issue with the paramedic (EMT-I) that cannulated my dad when he was burnt, he put the iv in the anticubical space of the right arm that was badly burnt, yet the left arm had veins sticking out like dogs B**ls and could easy cannulate and had less burns to it. I couldnt figure out why risk further infection. Protocol is avoid burn site, try another location and only as a last resort go to the burn site.

Scotty

[ERDoc]

It's not an ideal location to start an IV, but if you have no other option you can do it. I always look pretty seriously for another point of access if a victim is burned. I like to stay away from the burn site to avoid further pain to an already painful site, and also to avoid the risk of further introducing infection to the site. The two biggest problems for burn victims are fluid loss (dehydration) and infection. I try to cover the area that's burned with sterile dressings to prevent contamination. We usually have other options. Like I said, it's a last resort only to cannulate burn.

Shane

NREMT-P

I would have to agree with Shane, avoid it at all costs unless you absolutey cannot. The site is painful and an IV will hurt even more. Burns are a huge risk for infection and you are also providing direct access to the systmeic circulation for any bugs that might want to make their way in. You are seriously increasing the risk for sepsis. We don't even put central lines in over a burn and they are done under sterile conditions (gowns, masks, surgical drape, etc).

[VentMedic]

That IV will be removed very quickly if possible in the hospital as do most field sticks. However, whatever IV is available to start fluid rescusitation immediately will be used. The IV site will have to be capable of handling a large volume of fluids. If there is potential damage to the vessel itself, then it will be useless very quickly. The patient may be tubed, tubbed, bronched (if airway is an issue) and possibly taken to the OR all within the first two hours. In the OR they can place any type of line necessary for the long haul. Infection of course will be an issue, but they will probably have major antibiotic coverage.

Of course 3rd degree burns and obviously blistering sites are not feasible. Sometimes the hand veins are too small to run alot of fluids through, but they are a start. The burn team will be more upset about multiple unsuccessful sticks than a good stick that they can use until a secure line placement is obtained. A good burn team is very aware of the difficulty of starting IVs on burn patients due to a fluid redistribution and loss.

[TEAK]

But if you think about it how many burns have you seen that had both feet, hands, arms to where you could not get a IV.

This not only applies to burn patients. I have seen medics that will roll into the ed with no line going on a pt because they couldn't find anything to stick. Take off their shoes and they have veins that look like two ropes!

[brock8024]

That IV will be removed very quickly if possible in the hospital as do most field sticks. However, whatever IV is available to start fluid rescusitation immediately will be used. The IV site will have to be capable of handling a large volume of fluids. If there is potential damage to the vessel itself, then it will be useless very quickly. The patient may be tubed, tubbed, bronched (if airway is an issue) and possibly taken to the OR all within the first two hours. In the OR they can place any type of line necessary for the long haul. Infection of course will be an issue, but they will probably have major antibiotic coverage.

Of course 3rd degree burns and obviously blistering sites are not feasible. Sometimes the hand veins are too small to run alot of fluids through, but they are a start. The burn team will be more upset about multiple unsuccessful sticks than a good stick that they can use until a secure line placement is obtained. A good burn team is very aware of the difficulty of starting IVs on burn patients due to a fluid redistribution and loss.

I work in a burn center and not many of our patients go to surgery in the first 2 hours. Depending on if there is cirulation compromise then the patient may need escharotomies. Sorry for spelling.

In our burn center we have a central line placed in the ER for fluid replacement. Most pt's are behind on fluid anyways because of not having a IV or staff in other hospitals not giving the right amount. It seems that most are scared to give that much fluid. I have seen a few patients that get up to around 30 to 40 liters of fluid in a day or two.

As far as infection they are at higher rate of infection but that does not mean they start getting antibiotics when they hit the do. I know most of the time we wait for something to grow out before just guessing what to give.

This is the thing people can get an IV in a foot, leg , hand or arm. As far as the hand veins not working u will be surprised at home much fluid you can give in one. And at that point I think I am going to want a IV no matter how big , I mean life net.If you pt crashes while you are trying to get a big iv then you have no iv access. Something is better than nothing in some cases.

3rd degree is past blistering. At that point you are now to down to muscle and nerves are gone. 2nd degree burns can be deep but not to third yet. Burns can even convert to a different degree. Like a 2nd degree can convert to a 3rd degree in a matter of days.

[VentMedic]

Anyone interested in learning about burns a little more indepth should take Advanced Burn Life Support (ABLS) at a major burn center. Some burn centers offer other classes besides ABLS to any medical professional that is interested for CEUs.

[Spock]

I've done my share of burns and agree that most do not go to the OR immediately unless the burns are so extensive that debridement can't be done in the tub in the burn unit. Avoid the burn site at all cost when starting an IV and don't try multiple times. You just use up good veins because we pull field IV's within the first 2 hours. The saphenous vein will take a 14g easily in most patients if the arms are burned. Open the fluids wide (warm fluid) and make sure you give an accurate report on how much you have infused.

And always put in a normal size endo tube if you are intubating early. Another topic that has been addressed before but it is a pet peeve of mine and deserves mention again.

Live long and prosper.

Spock

[VentMedic]

We're a very large, fairly self contained burn center and like to get everythng done in the cleanest areas possible. Our OR and Tub rooms are almost next door to each other so that is why we'll take them in there for line placement or whatever else necessary depending on the type of burn. Positioning the patient for some posterior work is easier there as well.

For tubes, we'll take whatever they bring us. Appropriate size would be nice but, some EMS staff are very inexperienced with burns and like IVs we don't want a lot of pokes at the airway.

For our tubes, we like to get a subglottic suction tube in as early as possible if possible at least until they are trached. We've seen a big difference in our sputum cultures with those. That's all we stock now on our carts.

[letmesleep]

i was taught years ago that anything i might put on a burn would HAVE to be taken off the burn.......i would only imagine that an IV would be the same!