最近，外周插入的中央导管（PICC）在急性和重症监护环境中变得普遍和有效。烧伤患者需要特殊考虑，因为插入部位有限，烧伤伤口,高凝血,高感染率和其他。然而,烧伤患者中PICC的安全性尚未得到很好的阐明,也未形成相关方案.本研究旨在调查烧伤患者PICC的血栓形成和感染情况。
这是一项单中心回顾性研究和系统评价。纳入2018年1月1日至2020年12月31日期间发生PICC的所有烧伤患者。对Medline的系统搜索，PubMed,EMBASE和WebofScience从成立到2021年6月4日，遵循PRISMA指南。上肢静脉血栓形成（UEVT）和中线相关血流感染（CLABSI）是主要结果。
共纳入78例患者中的85例成功的PICC。大多数患者为男性（79.5%），成人（80.8％）和火焰伤害（74.4％）。平均TBSA为50.3%，76.9%的患者TBSA超过30%。大多数PICC通过基底静脉穿刺一次（60.0％）并在损伤后不到30天（80.0％）插入（70.6％）。全线天数为2195天,平均线天数为25.8±18.3天。插入后21.2±17.3天，有6个PICC并发UEVT（7.1％）。UEVT患者的菌血症发生率和插入时间明显高于无UEVT患者。一名患者出现CLABSI，CLABSI率为1.2%，每1000行天数为0.5。六个PICC有导管定植。没有发现显著的危险因素。对涉及293例患者和319例PICC的5篇文章进行了系统评价。在烧伤人群中，UEVT的总发生率为3.2%，CLABSI为6.9%。
烧伤患者的PICCs具有可接受的UEVT和CLABSI发生率，且具有相对较长的行持续时间。需要针对烧伤患者的标准化PICC指南，以进一步提高PICC的可行性和安全性。
Peripherally inserted central catheters (PICCs) are becoming common and effective in acute and critical care settings recently. Burn patients need special considerations because of restricted insertion sites, burn wounds, hyper coagulation, high infection rates and others. However, the safety of PICCs in burn patients are not well elucidated and no related protocol has been formed. This study aims to investigate the thrombosis and infections of PICCs in burn patients.
This was a single center retrospective study and a systematic review. All the burn patients with PICCs between January 1, 2018 and December 31, 2020 were included. A systematic search of Medline, PubMed, EMBASE and Web of Science was performed from inception to 4 June 2021 following PRISMA guidelines. Upper extremity vein thrombosis (UEVT) and central line-associated bloodstream infection (CLABSI) were the main outcome.
A total of 85 successful PICCs in 78 patients were included. Most patients were male (79.5%), adults(80.8%) and injured by flame(74.4%). The mean TBSA was 50.3% and 76.9% of patients had TBSA more than 30%. Most PICCs were punctured once (60.0%) and inserted less than 30 days after injury (80.0%) through basilar vein (70.6%). The overall line days were 2195 days and the mean line days was 25.8 ± 18.3 days. Six PICCs were complicated by UEVT (7.1%) in 21.2 ± 17.3 days after insertion. Patients with UEVT had significantly higher rate of bacteremia and later insertions than those without UEVT. One patient developed CLABSI and the CLABSI rate was 1.2% and 0.5 per 1000 line days. Six PICCs had catheter colonization. No significant risk factors were identified. Five articles involving 293 patients and 319 PICCs were ultimately evaluated in systematic review. The overall incidence of UEVT was 3.2% and CLABSI was 6.9% in burn populations.
PICCs in burn patients had acceptable incidence of UEVT and CLABSI with relative long line durations. A standardized PICC guideline for burn patients is required to further improve the feasibility and safety of PICCs.
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