CICU/CCU Clinical Pathway for Children with Suspected Sepsis

High-risk Conditions
  • Cardiac
  • Infants with a single ventricle
  • Recent device/implant
  • Immune
  • Immune suppression
  • Chronic steroids
  • 22q11 deletion
  • Asplenia, Sickle Cell Disease
  • Malignancy
  • Transplant recipient
  • General
  • Central line, urinary catheter
  • Technology dependent
    • Trach, VP Shunt, G-tube
  • Age < 56 days
  • Severe developmental delay, CP
  • For occluded/malfunctioning central lines:
  • Do not delay culture/antibiotics
  • Consider peripheral IV
  • If unable to gain IV access in 30 minutes consider:
  • IM/IO
  • CVL placement
  • Cath lab assist/surgical cutdown
  • If re-occurring fever/sepsis concern:
  • Consult ID for additional interventions/recommendations

Temperature Abnormality

≤ 56 days T ≥ 38°C
> 56 days T ≥ 38.5°C
All ages T < 36°C

And 1 or more of the following:
Mental status change: Agitation, distress,
inconsolable, lethargy
Perfusion change: cool, mottled, grey
High-risk condition: See box at right.

Low Concern for Sepsis
High Concern for Sepsis
  • Notify:
  • Bedside RN, FLOC, CICU/CCU Attending
  • Consider antipyretic
  • Consider lab studies
  • Reassess in 1 Hour
  • Notify:
  • Bedside RN, FLOC, Charge RN, CICU/CCU Attending
Escalate Care without Delay
  • Ensure IV access
  • Obtain blood culture
    • Bedside RN or FLOC
    • Do not wait for phlebotomy
  • Administer 1st antibiotic within 60 minutes
    • Use Suspected Sepsis Order Set
    • Do not delay antibiotic administration to obtain other labs (e.g., Cx, CBC, CRP, etc.)
Risk for Hypovolemia
Low Cardiac Output
  • Increased insensible loss
  • High output drain loss
  • Child on 2 or more diuretics
  • Bleeding
  • Vomiting, diarrhea
  • Known cardiac dysfunction
  • Poor response to fluid resuscitation
  • Consider Normal Saline Bolus
    • 10 mL/kg bolus
    • RN/FLOC reassessment for clinical response and need for additional fluid
  • Notify: CICU Attending, CT Surgeon, Charge RN
  • Consider: 1st line vasoactive medications
    • Dopamine or Epinephrine
Consider Additional IV Access
CVL/CVP volume, medications
Arterial Access BP monitoring, blood samples
Refractory Shock Considerations
  • Stress dose hydrocortisone
  • Echo (fluid function check)
  • Chest X-ray (pneumothorax)
  • Pressure sensing urinary catheter (intra-abdominal hypertension)
Posted: July 2017
Revised: December 2022
Authors: G. Bird, MD; E. Schwartz, CRNP; K. Chiotos, MD; K. Pough, PharmD; S. Schachtner, MD; D. Holbein, CRNP; C. Field, RN; M. Yowell, CRNP; S. Helman, RN; S. Moran, RN