Clinical Pathway for Blood Culture Acquisition in PICU/PCU
Patient with Fever (Non-Oncology/Non-Neutropenic)

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.

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  • Signs of instability
  • Review all current/recent:
    • Vital signs, urine output, physical exam
    • Culture results in the last 48 hours
    • Radiographic studies
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Concern for Sepsis
Start PICU Sepsis Pathway
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Assess the following to determine if suspicion for bacteremia is low:
  1. Fever within expected time course for identified viral infection
    • OR
  2. 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
  3. 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
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Low-Suspicion for Bacteremia
  • Blood culture NOT routinely indicated
  • Defer and monitor
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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