ED Clinical Pathway for Evaluation/Treatment of Non-oncology Patients with a Central Venous Catheter (CVC) and Fever
  • Excluded patient populations or therapies
  • Oncology
  • Stem cell transplant
  • Engineered cell therapy
  • Pulmonary hypertension
  • Hyperinsulinism
  • Cystic fibrosis
  • Aplastic anemia

Triage

EPIC Sepsis Alert, Sepsis Huddle/Pathway as Indicated

RN/MD/CRNP Team Assessment

Monitors, VS
Immediate CVC access - all lumens
Order labs, blood cultures, antibiotics
Consider need for hydrocortisone
Aim for 1st antibiotic within 1st hour

  • Intestinal Failure
  • Home Parental Nutrition
  • Complex Care Service
  • Sickle Cell Disease with Apheresis Port
  • Hemophilia with Broviac/PICC
Cefepime
Liver Transplant
Piperacillin/Tazobactam
Metabolism with Port
Hemophilia with Port
Ceftriaxone
Hemodialysis
1. Cefepime
2. Vancomycin
Review Indications for Vancomycin
Add Vancomycin for the following indications
  • Ill appearance
  • Presence of hemodialysis catheter
  • History of MRSA
    • Review MDRO, prior blood cultures, and outpatient notes
  • Suspected MRSA infection
    • Skin OR soft tissue infection
      • Including line exit site or tunnel infection
    • Deep tissue abscess
    • Lobar pneumonia
  • Concern for CNS infection
    • Meningitis/ventriculitis
  • Non-central line indwelling hardware
    • VP shunt, prosthetic valve
Posted: September 2017
Revised: May 2019
Authors: B. Ku, MD; MK Abbadessa, RN; L. Riede, RN; R. Mann, CRNP; J. Gerber, MD; M. Hayes, PharmD; T. Bales, MD; L. Copelovitch, MD; D. Friedman, MD; B. Laskin, MD; P Mazzeo, MD; L. Rand, MD; C. Witmer, MD; D. Barsky, MD; J. Lavelle, MD