Blood Culture, PICU Clinical Pathway — ICU | Children's Hospital of Philadelphia

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Goals and Metrics

Provider Resources

Related Pathways

Blood Culture Acquisition in PICU/PCU Patient with Fever
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.

Clinician/Team Assessment for Infection

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
Start PICU Sepsis Pathway

Additional Guidance:

No Concern for Sepsis
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
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

Posted: September 2018
Authors: C. Woods-Hill, MD; K. Chiotos, MD; S. Coffin, MD; A. Linehan, RN

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.