Pediatric Guidelines
Fever and Central Line

Fever and Central Line

Background

  • Pediatric patients with central line and an acute febrile episode ≥ 38°C
  • Clinical suspicion of central line infection¹

¹ High risk for CLABSI

  • Chronic illnesses
    • hemodialysis
    • malignancy
    • gastrointestinal tract disorders
    • pulmonary hypertension
  • Immune compromised states
    • hematopoietic cell transplant
    • endstage renal disease
    • diabetes mellitus
  • Malnutrition
  • Total parenteral nutrition (TPN)
  • Extremes of age
  • Loss of skin integrity (burns)
  • Prolonged hospitalization prior to line insertion
  • Catheter type
  • Catheter location (femoral line has the highest risk, followed by internal jugular than subclavian)
  • Conditions of insertion (emergent vs elective)
  • Catheter site care
  • Skill of catheter inserter
  • Hem/Onc patients with ports
  • Infants < 1 month
  • Consider obtaining fungal cultures if immunocompromised¹ and/or ill appearing appearing
  • For all TPN dependent patients, please obtain fungal cultures

¹ Risk factors for fungal disease: There is no clear guideline for when to begin empiric antifungal treatment, but typically empiric therapy should begin with presence of known risk factors.

Known risk factors include :

  • extreme prematurity
  • prolonged broad spectrum antibiotics
  • bone marrow or solid organ transplantation
  • abdominal surgery
  • central venous catheter
  • corticosteroids
  • dialysis
  • necrotizing pancreatitis
  • ongoing use of parenteral nutrition

Initial Provider Assessment

SIRS Criteria

  • Tachycardia (for age)
  • Tachypnea (for age)
  • Temperature ≤36°C or ≥38°C
  • WBC <4K, >12K or bands >10%

More Information

For questions please email [email protected]

  • Approval date February 2020
  • Next revision date February 2022
  1. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad, II, Rijnders BJA, Sherentz RJ, Warren DK. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter Related Infection: 2009 Update by Infectious Disease Society of America. Clinical Infectious Disease. 2009;49:1-45
  2. https://www.chop.edu/clinical pathway/fever-non-oncology-cvc-clinical-pathway
  3. https://www.seattlechildrens.org/pdf/central-line-infection-pathway.pdf