What if patient has a fever?
- Refer patient to the emergency department. Do not reassure family over the phone. For red flag symptoms, tell them to dial 911 (altered mental status, chills, seizures). Tell family to anticipate admission for at least 48 hours.
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Call in Expect to ED saying that patient who is “central line dependent coming into ED”.
- If going to BCH, tell operator to use “ED Short Gut/Home PN/Fever plan” (see image below), request someone to personally call you back to close loop on plan once patient has been seen. Consider notifying surgery on-call if concerning story.
- If going another ED, recommend: CBC with diff, Chem 18, CRP, blood cultures from CVC and peripheral. If history of UTI, UA and urine culture.
- Empiric antibiotics: Vanco/Zosyn. Use linezolid for Vanco allergy. Use meropenem for Zosyn allergy.