ED 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
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Triage

EPIC Sepsis Alert, Sepsis Huddle/Pathway As Indicated

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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

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  • Intestinal Failure
  • Home Parenteral Nutrition
  • Complex Care Service
  • 1. Cefepime
  • 2. Vancomycin
  • Liver Transplant
  • 1. Piperacillin/
        Tazobactam
  • 2. Vancomycin
  • Hemodialysis
  • 1. Cefepime
  • 2. Vancomycin
  • Metabolism
    with Port
  • 1. Ceftriaxone

  • If ill appearing,
    instead of
    Ceftriaxone:
    1. Cefepime
    2. Vancomycin
  • Sickle Cell Disease with Apheresis Port*
  • 1. Cefepime
  • *For patients with apheresis port who do not have sickle cell disease, contact primary service for antibiotic recommendations
  • Hemophilia
  • Broviac/PICC
  • Port



  • If ill appearing,
    instead of
    Ceftriaxone:
    1. Cefepime
    2. Vancomycin
  • 1. Cefepime
  • 1. Ceftriaxone
Piperacillin/Tazobactam should be substituted for Cefepime/Ceftriazone for all suspected intra-abdominal sources
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  • If ill appearing:
    Add Vancomycin if not already ordered
    Consider Sepsis Pathway
Posted: September 2017
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