1 IntroductionExtremely severe burns in adults are characterized by a total burn area > 50% or a third-degree burn area > 20%1. The treatment of such patients is a complex challenge. Maintaining unobstructed infusion at all times is the key to successful treatment, as early hypovolemia and insufficient effective blood circulation can cause multi-system organ dysfunction and affect patient outcomes2.The clinical treatment of extremely severe burn patients faces difficulties in establishing venous access, directly influencing the demands of intravenous fluid infusion and emergency rescue. This is due to severe superficial venous disfigurement and limited exposed skin after multiple skin grafting operations. A peripherally inserted central catheter (PICC) is a deep vein catheter inserted through a peripheral vein, with the catheter tip positioned in a central vein. PICC has the advantages of minimal pain during puncture, long retention time, vascular protection, and low risk of infection. Therefore, it is widely used in medium to long term intravenous infusion, infusion in elderly patients, and rescue treatment of patients with extensive burns, during major surgeries, and in critical conditions. Studies have shown that the infection rate associated with PICC catheterization is lower than that of subclavian and internal jugular vein catheterizations3,4. Retrospective studies revealed that the incidence of catheterization-related infections in burn patients after PICC catheterization is only 12.9/1,000 catheter days5,6. In this context, PICC placement addresses the challenge of rapid intravenous infusion and helps reduce infections in patients with extremely severe burns.On October 23, 2021, the Department of Burns and Plastic Surgery of our hospital admitted a patient with 93% of the body burned and burn depth of II-IV degrees. After multiple escharotomies and skin grafting operations, the patient entered the recovery stage. To correct hypovolemic shock, further fluid rehydration treatment was necessary. After consultation, the intravenous therapy group performed ultrasound-guided PICC catheterization, and the catheter was kept in place for 14 days.