Inpatient Clinical Pathway for Management of Infants with Lymphatic Disorders

Lymphatic Flow Disorder Suspected
  • Review of history and physical
  • Draw Initial Labs
    • Cell count (body fluid)
    • Triglycerides (body fluid)
    • Alpha 1 antitrypsin (stool)
    • Albumin (serum)
  • Obtain Initial Imaging
    • CXR and/or chest ultrasound for pleural effusions
    • Abdominal ultrasound for ascites
  • Place chest tube/peritoneal drain as needed
Assess Diagnostic Criteria
  • Physical finding: edema or anasarca
  • Abnormal lab values
  • Abnormal fluid collection on imaging
Lymphatic Flow Disorder Confirmed
Performed by interventional radiologist/ cardiologist in the Cardiac Cath Lab
Ongoing Management
Individualized for Each Patient
  • Medical Management
    • Fluid Replacement
      • Replace drainage when > 20 mL/kg/day
      • Fresh frozen plasma (FFP) and Normal
      • Saline (NSS), ½ NSS, or lactated Ringer's
    • Serum albumin goal > 2.5 or 3 g/dL
      • 0.5-1 g/kg/dose 25% IV albumin
Assess Discharge Readiness
  • Drain removal for at least 24 hours
  • Stable or decreased effusions on CXR
  • Oxygen: requirement stable for home
  • Diet: tolerating full feeds or home diet plan in place
  • Schedule follow-up

Posted: July 2022
Revised: September 2022
Authors: D. Taha, DO; E. Pinto, CRNP; M. Begany, MS; A. Branas, PT; M. Burkhardt, MS; V. Bustard; E. Cross, PT; R. DeLeo, MS; C. McCabe, MSN; E. Young, MSN; M. Savoca, MS; M. Snyder, MSN; M. Stetzer, MSN; K. Zbarsky, CRNP