Fever Non-Oncology CVC Clinical Pathway — Emergency Department

Labs and Diagnostic Testing

Blood Culture	Send a blood culture from all CVC lumens before antibiotic therapy and Consider obtaining a peripheral culture instead of a central venous catheter culture if: Central venous access would result in child's deterioration The central venous catheter is damaged or does not have sufficient blood return
CBC with Differential

Further Diagnostic Testing as Clinically Indicated

Urine	Consider UA, culture as clinically indicated; UTI Pathway Beta-HCG for all post-pubertal females and females ≥ 12 yrs
CXR	As clinically indicated
Respiratory PCR Panel	As clinically indicated Rapid PCR quad panel SARS-CoV-2, Flu A/B, RSV test in children with influenza-like illness Influenza/Flu Pathway
Type and Screen	As clinically indicated

Special Consideration per Patient Population

Intestinal Failure, Home Parenteral Nutrition	TPN panel
Nephrology/Hemodialysis	CBC, CRP, CMP UA, culture as indicated, do not delay antibiotic therapy Guidelines for the Evaluation and Treatment of Central Line Associated Bloodstream Infection (CLABSI) of a Hemodialysis Catheter
Metabolism	Refer to Metabolism ED letter for additional labs as indicated
Sickle Cell Disease	CBC w/diff, reticulocyte count Sickle Cell Disease with Fever Pathway

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

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.