PTO

Paediatric
Sepsis 6
Date:
Sepsis kills - this tool can help keep your patient safe
Addressograph
Apply this document if infection is suspected, AND
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Consider whether there is an obvious alternative diagnosis e.g. uncomplicated RSV Bronchiolitis
TIME Reason(s) Why Sepsis 6 Not Initiated:
START THE CLOCK NOW
Signature
TIME SIGNATURE
Your patient has 2 or more of the following:
Temperature < 36C or > 38.0C
Inappropriate Tachycardia
Altered mental state (Sleepy, irritable lethargic, floppy)
Reduced Peripheral Perfusion (Cap Refill > 2 secs, Demarcation, Mottled)
Petechial or Purpuric Rash
Increased Respiratory Effort, Tachypnoea or SpO
2
<94% in Air
Systolic hypotension as scored on PEWS chart
:

Have a lower threshold for initiating treatment if:
Under the age of 3 months, Chronic disease or complex needs
Recent surgery Immunocompromise
Chickenpox Indwelling medical devices
Significant parental concern Neutropenia
TIME Signature Please document any deviations or Variations from Protocol:
Time Initials
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Paediatric Sepsis 6
Complete all Elements Within 1 Hour
Give High Flow Oxygen: 10-15 LPM Via Face Mask
Get Access: IV or I/O
a) Blood Cultures, BM: I/O or IV
c) Blood Lactate, Blood Gas, Clotting, FBC, U&E & CRP: IV ONLY
IF YOU CAN ONLY GET IO ACCESS MOVE ON TO 3. NOW
Give Antibiotics: IV or I/O Broad Spectrum Cover as shown overleaf
Fluid Resuscitate: If indicated - have a low threshold for intervention
- 20ml/kg 0.9% Saline Repeated as required
- Large quantities of fluid may be required
-Carefully assess after each bolus
Involve Senior Clinicians / Specialists Early:
- Critically ill children are a team sport
-CALL FOR BACKUP from Consultants, Anaesthetists and Retrieval services
Consider Adrenaline Infusion Early
- If still looks shocked after 40ml/kg Fluids start ADRENALINE infusion
This can be given via peripheral IV if necessary (See guide overleaf)
Day Bleep 4004 Biochemistry Call 4210 / 4211
Night Bleep 6025 Bleep 1057
Paediatric Consultant on-call Call switch X-Ray Call 4303 / 4304 / 4305
Anaesthetic Reg On-call Bleep 4002 Bleep 5051
Anaesthetic Consultant On-call Call switch Edinburgh 0131 536 0919
ITU Call 4446 Glasgow 0141 201 6923
IV Cefotaxime Under 7 Days 25mg/kg every 12 Hrs
7 - 21 Days 25mg/kg every 8 Hrs
21 - 28 Days 25mg/kg every 6 - 8 Hrs
1 Month - 18 Years 50mg/kg every 8 - 12 Hrs
Antimicrobial Prescribing
Dose doubled in severe
infection and meningitis
Every 6 Hrs in very severe
infections & meningitis
(Max. 12 g daily)
Inotrope Prescribing
If origin of Sepsis is known, or if neonate, please follow Management of Infection in Paediatric Patients
If febrile neutropenic, please follow Immunocompromised Child with Fever guideline
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48.2
Volume of 5% Glucose to Add to
give total Volume of 50ml (ml)
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Directory
If normal physiological parameters are not restored after 40ml/kg Fluids,
start on ADRENALINE infusion immediately to facilitate emergency transfer to Anaesthetics
ADRENALINE Via Peripheral IV, Intraosseous (I/O) or Central (CVC) Line:
Run at 0.01-1 microgram/kg/min
= 0.1 - 10ml/hr
START AT 1ml/hr
Retrieval Hotline
Can be changed to
Ceftriaxone once
stabilised and
condition seen to
improve
Paediatric Registrar
If ANAPHYLACTIC to
Penicillin
Make clinical decision on alternative therapy if there is a solid history of extreme
reaction to Penicillin, otherwise see above
Septicaemia of
Unknown Origin
48.5
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47.6
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38.0
41.0
10.8
11.4
1ml/hr =
0.1 microgram/kg/min
0.3mg/kg (0.3ml/kg of 1:1,000)
ADRENALINE diluted up to 50ml total
volume with 5% Glucose
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Volume of 1:1000
ADRENALINE (ml)
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Patient WEIGHT
(kg)
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Further fluid boluses may be needed in addition to the ADRENALINE infusion
Flush the access device well with Saline and immediately connect the still running ADRENALINE infusion as close
to the patient as possible. You may need to remove the IV extension set and prime it with ADRENALINE before
reconnecting
There will be some delay before the ADRENALINE reaches the patient's circulation due to dead space in the
catheter. Some indwelling CVC lines such as Portacaths have considerable deadspace. Clinicians may wish to run
the ADRENALINE at a higher rate until it takes effect in these cases.
Based upon work by Dr Jeremy Tong (jtong@nhs.net). Adapted for the NHS Highland Sepsis 6 Group by Aaron Carr (aaron.carr@nhs.net)
Paediatric Sepsis 6 Version 1.6
Inotrope Infusion Guideline
ADRENALINE is an Inotrope (or Vasopressor). It is a very powerful vasoactive drug which can be used to support
circulation. It does this by increasing cardiac stroke volume to improve cardiac output while simultaneously constricting
peripheral vasculature to centralise the circulating volume to vital organs.
Despite these dangers, early use of Inotropes in children suffering from septic shock have been shown to improve
outcome and children requiring this therapy should receive it, regardless of where they should happen to be
resuscitated.
ADRENALINE has an extremely short half life, i.e. it is metabolised quickly and any interruption to an Adrenaline infusion
given to a critically ill child can lead to sudden loss of blood pressure and cardiovascular collapse. Conversely, a bolus of
this drug can lead to a dangerously high spike in blood pressure with attendant bradycardia, known as the Cushing
effect.
Inotropes only to be given under direct supervision and CONTINUOUS
ATTENDANCE of a senior clinician or anaesthetist
Outwith ITU or anaesthetic care area only ADRENALINE infusion should be used.
Make up infusion as detailed above in a clearly labelled 50ml Syringe. Mix well.
The child should be transferred within 30 minutes to ITU, anaesthetic room, or similar anaesthetist led care area.
If anaesthetics not already in attendance, make 2222 CRASH call
Connect a giving set and 3-Way tap at the patient end. Prime both with the ADRENALINE infusion
Care should be taken to prevent interruption of infusion or bumps to syringe driver. Ensure syringe driver is
plugged into mains whenever possible
No other infusions, boluses, drugs, fluids or flushes OF ANY KIND should be made through the same infusion
catheter - this is a dedicated line
Before connecting to patient, place syringe in an Alaris Asena syringe driver and run at 1ml/hr
Set monitor to make automatic blood pressure (NiBP) measurements every 3 minutes. Put patient on ECG
monitoring if not already.
May 2014 - Review By Nov 2014
It is safe to give ADRENALINE via peripheral IV, but the Intraosseous route is preferred if already established.