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Recommended Laboratory Studies

Blood

Frequency

Comment

Blood culture*

 

Obtain prior to antibiotics when possible, but do not delay antibiotic administration

ABG, VBG, lactic acid and ionized calcium

Q 2hr, prn

If no arterial line, draw VBG from CVL 

Central venous oxyhemoglobin saturation

Q 2hr, prn

Preferentially drawn from CVL with tip at SVC/RA junction (results from femoral lines may be less reliable, trends are useful).

May be obtained via co-oximetry or on a venous blood gas sent to central lab. Oxyhemoglobin saturation obtained via central lab blood gas analysis is measured, not calculated, however, it is a calculated value when obtained via iStat. Oxyhemoglobin fraction is obtained via the co-oximetry test. The blood gas oxyhemoglobin saturation and co-oximetry oxyhemoglobin fraction have the same value in the absence of dyshemoglobinemia. Thus, in most cases, if a venous blood gas is clinically indicated and sent to the lab, sending a co-oximetry test in addition to measure oxyhemoglobin saturation is not necessary.

POC glucose

Q 2hr

If not checking glucose via blood gas

CBC, differential

Q 12hr, prn

If not checking glucose via blood gas

PT/INR/PTT, fibrinogen

Q 12hr, prn 

 

BMP

Q 12hr, prn

 

Mg

Q 12hr, prn

 

Phos

Q 12hr, prn

 

Amylase, lipase

Q 24hr, prn 

 

Hepatic function panel

Q 24hr, prn

 

CRP

Q 24hr

 

Procalcitonin

Q 24hr 

Optional test

Type and Screen

Q 72hr 

 

Cortisol

Random

Send if risk of adrenal insufficiency

  • Catecholamine resistant shock

  • Purpura fulminans

  • Congenital adrenal hyperplasia

  • Prolonged steroid treatment (> 2 weeks)

Urine

   

Urinalysis, culture

   

Urine HCG

once

All females ≥ 12 years, and females < 12 years that have experienced menarche

Other

   

Respiratory Gram Stain, culture

 

If ETT, tracheostomy

Respiratory PCR Panel

 

If URI symptoms, signs

Enteroviral Studies

 

June – October

PCR of blood, urine and CSF (if obtained)

Stool culture, routine

 

As clinically indicated if hospitalized < 48 hours

CSF profile, gram stain, culture

 

As clinically indicated

Mycoplasma PCR

 

Consider if pneumonia present

PCR from blood, naso pharyngeal aspirate

Rocky Mountain PCR

 

Consider if petechial/purpuric rash, hyponatremia, low platelets,  PCR blood

*Blood cultures are ideally drawn prior to antibiotic administration. While blood culture is currently the gold standard for blood stream infection, sensitivity is greatly affected by collection site and technique, number of cultures, volume of blood drawn, and interpretation of results (timing and pathogen).

Buttery, Arch Dis Child Fetal Neonatal Ed 2002; 87:F25-F28.

Retrieved from: http://www.chop.edu/clinical-pathway/severe-sepsisseptic-shock-icu-clinical-pathway-infants-28-days-and-children-10

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.