PICU/PCU Clinical Pathway for Blood Culture Acquisition in Children with Fever (Non-Oncology/Non-Neutropenic)
Blood Culture Acquisition in PICU/PCU Patient with Fever
Temperature ≥ 38.5°C
Temperature ≥ 38.5°C
Exclusions: ≤ 56 days old, oncology/bone marrow transplant patients, solid organ transplant, immunocompromising conditions (including primary immunodeficiency sickle cell disease, aplastic anemia or neutropenia) or immunosuppressive medication, and patients on CRRT, ECMO or thermoregulation devices.
- Respiratory Culture Algorithm
- Signs of instability
- Review all current/recent:
- Vital signs, urine output, physical exam
- Culture results in the last 48 hours
- Radiographic studies
Concern for Sepsis
Additional Guidance:
No Concern for Sepsis
Guidance for Patients with or without Central
Venous Line
Guidance for Patients with or without Central
Venous Line
Assess the following to determine if suspicion for bacteremia is low:
- Fever within expected time course for identified viral infection
- OR
- Persistent fever (last fever was within less than 48 hours) in a patient:
- with or without an identified bacterial
non-bloodstream infection - AND
- Blood culture obtained within the last 48 hours which is negative to date
- OR
- with or without an identified bacterial
- Identified non-infectious source of fever:
- Increased WAT scores
- Postop within 24-48 hours
- Dysautonomia
- Intracranial hemorrhage
Assess the following to determine if suspicion for bacteremia is moderate or high:
- Clinical presentations not listed/considered under low-suspicion category
Low-Suspicion for Bacteremia
- Blood culture NOT routinely indicated
- Defer and monitor
Moderate or High Suspicion for Bacteremia
- Blood culture indicated
- Guidance for Blood Culture Sources
Continually re-evaluate for changes in patient status
Signs of Instability
Signs of Instability
Posted: September 2018
Revised: October 2020
Authors: C. Woods-Hill, MD; K. Chiotos, MD; S. Coffin, MD; A. Linehan, RN
Revised: October 2020
Authors: C. Woods-Hill, MD; K. Chiotos, MD; S. Coffin, MD; A. Linehan, RN
Evidence
- Association of a Clinical Practice Guideline With Blood Culture Use in Critically Ill Children
- Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections
- Blood culture contaminants
- Importance of blood cultures from peripheral veins in pediatric patients with cancer and a central venous line
- Contamination rates of arterial catheter cultures
- Practical Guidance for Clinical Microbiology Laboratories: A Comprehensive Update on the Problem of Blood Culture Contamination and a Discussion of Methods for Addressing the Problem