Sepsis — Immediate IV Access, IV Escalation Plan — Clinical Pathway: Emergency Department, Inpatient and PICU

Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Immediate IV Access, IV Escalation Plan

Goals

  • Establish large bore IVs and begin fluid resuscitation within the first 15 minutes
  • Implement IV escalation pathway considering the individual patient
    • Consider use of existing central access. It is preferable to give antibiotics through a pre-existing central line if it does not delay antibiotic administration or other therapies.
    • Give vasoactive infusions through central access, when available, but do not delay administration of vasoactive infusions if there is no central access.

Suspected Sepsis IV Access and Escalation Plan

0-5 min
  • First peripheral IV with largest gauge possible
    • Consider US guided peripheral IV if no visible/palpable veins
  • Consider IO immediately in severely ill patients
  • If inpatient/PICU: Notify vascular access specialist team
5-10 min
  • Second peripheral IV attempt
    • Consider US guided peripheral IV
    • Consider external jugular EJ
  • If ED: Notify vascular access team
10-15 min
  • If still no access (or insufficient access)
    • IO
    • EJ
    • Central line (IJ preferred for ScvO2 and CVP monitoring)
    • Consider IR or general surgical fellow as additional resource

Refer to Inpatient Clinical Pathway for Vascular Access or ED Clinical Pathway for Vascular Access for additional resources and guidance.