Emergency Department Clinical Pathway for Evaluation/Treatment of
Non-oncology Patients with a Central Venous Catheter (CVC) and Fever
Related Pathways
- Excluded patient populations or therapies
- Oncology
- Stem cell transplant
- Engineered cell therapy
- Pulmonary hypertension
- Hyperinsulinism
- Cystic fibrosis
- Aplastic anemia
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
Hemophilia with Port
Ceftriaxone
Hemodialysis
1. Cefepime
2. Vancomycin
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
- Skin OR soft tissue infection
- Concern for CNS infection
- Meningitis/ventriculitis
- Non-central line indwelling hardware
- VP shunt, prosthetic valve
- 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
- Skin OR soft tissue infection
- 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, 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
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
- Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-related Infection
- Outcome of Pediatric Gastroenterology Outpatients with Fever and Central Line
- Characteristics of Catheter-related Bloodstream Infections in Children with Intestinal Failure
- The Rate of Bloodstream Infection is High in Infants with Short Bowel Syndrome