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Fever, Non-Oncology CVC Clinical Pathway – Emergency Department

Emergency Department Clinical Pathway for Evaluation/Treatment of
Non-Oncology Child ≥ 56 Days with a Central Venous Catheter (CVC) and Fever

  • Exclusions
    • Oncology
    • Stem cell transplant
    • Engineered cell therapy
    • Pulmonary hypertension
    • Hyperinsulinism
    • Cystic fibrosis
    • Aplastic anemia
 
 
 
 

ED Team Assessment

 
 
 
 
  • 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
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
  • Suspected CNS infection
    • Meningitis/ventriculitis
  • Non-central line indwelling hardware
    • VP shunt, prosthetic valve
  • Allergy to cephalosporin
    Assess need for alternative prior to avoiding first line beta-lactam
  • Consult appropriate subspecialty as clinically indicated
  • Disposition planning should occur with subspecialist and inpatient admission is determined on case-by-case basis
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