Fever Non-Oncology CVC Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Provider Resources

Related Pathways

Exclusions:
Oncology
Stem cell transplant
Engineered cell therapy
Pulmonary hypertension
Hyperinsulinism
Cystic fibrosis
Aplastic anemia

Non-oncology Child with a
Central Venous Catheter (CVC) and Fever

ED Triage

ED EHR Sepsis Alert, Sepsis Pathway as indicated

ED Team Assessment

Access CVC — all lumens
Order labs, blood cultures, antibiotics
- Consider urine testing as indicated
- Consider need for stress dose steroids

Goal: 1st antibiotic administration within 1st hr
ED Nursing CVC Care Tips
History and Physical Exam
Further Diagnostic Testing

Antibiotic Recommendations
- Signs/symptoms sepsis, Sepsis, ED, Inpatient, PICU
CHOP Antibiogram

Intestinal failure
Home parental nutrition
Complex care service
Sickle cell disease with apheresis port
Hemophilia with Broviac/PICC

Cefepime

Liver transplant

Piperacillin/tazobactam

Metabolism with port
Hemophilia with port

Ceftriaxone

Hemodialysis

1. Cefepime
2. Vancomycin

Add Vancomycin for the Following Indications

Ill appearance
- Sepsis, ED, Inpatient, PICU
Presence of hemodialysis catheter
History of MRSA
- Review MDRO, prior blood cultures, and outpatient notes
Suspected MRSA infection
- Skin or soft tissue infection
  - Including line exit site or tunnel infection
- Deep tissue abscess
- Lobar pneumonia
Suspected CNS infection
- Meningitis/ventriculitis
Non-central line indwelling hardware
- VP shunt, prosthetic valve

Consult appropriate subspecialty as clinically indicated
Disposition planning should occur with subspecialist and inpatient admission is determined on case-by-case basis

Posted: September 2017
Last Revised: November 2024

Authors:
- B. Ku, MD;
- MK. Abbadessa, ACCNS-P;
- J. Gerber, MD;
- C. Bales, MD;
- L. Copelovitch, MD;
- D. Friedman, MD;
- B. Laskin, MD;
- P Mazzeo, MD;
- L. Rand, MD;
- C. Witmer, MD;
- J. Lavelle, MD;
- M. Mascarenhas, MD;
- M. Boettcher, CRNP;
- G. Sharer, ACCNS-P;
- R. Heckler, RN

Editors: Clinical Pathways Team

Evidence

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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.

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Emergency Department Clinical Pathway for Evaluation/Treatment of Non-oncology Child ≥ 56 Days with a Central Venous Catheter (CVC) and Fever

Evidence

Emergency Department Clinical Pathway for Evaluation/Treatment of
Non-oncology Child ≥ 56 Days with a Central Venous Catheter (CVC) and Fever