Fever Non-Oncology CVC Clinical Pathway — Emergency Department

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Goals and Metrics

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Excluded patient populations or therapies
Oncology
Stem cell transplant
Engineered cell therapy
Pulmonary hypertension
Hyperinsulinism
Cystic fibrosis
Aplastic anemia

Non-oncology Patient with a
Central Venous Catheter and Fever

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

Antibiotic Recommendations
- Concern for sepsis, Sepsis, ED, Inpatient, PICU
CHOP Antibiogram

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
- Sepsis, ED, Inpatient, PICU
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

Ill appearance
- Sepsis, ED, Inpatient, PICU
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

Pilot communication plan for Complex Care and Intestinal Failure Patients

Subspecialty Consult and Disposition Planning

Posted: September 2017
Revised: May 2019
Authors: B. Ku, MD; MK. Abbadessa, ACCNS-P; 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

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.

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Emergency Department Clinical Pathway for Evaluation/Treatment of
Non-oncology Patients with a Central Venous Catheter (CVC) and Fever

Evidence

Emergency Department Clinical Pathway for Evaluation/Treatment ofNon-oncology Patients with a Central Venous Catheter (CVC) and Fever

Evidence

Emergency Department Clinical Pathway for Evaluation/Treatment of
Non-oncology Patients with a Central Venous Catheter (CVC) and Fever