Cardiac Catheterization Should Have A Liberalized Preoperative Fasting Protocol

2073 words - 8 pages

In medicine, there are innumerous amounts of tests and procedures performed every day. These procedures irrespective of how invasive or noninvasive they are require patients to be ‘Nil per Oral’ (NPO) for several hours prior to the procedure. Traditionally fasting preoperatively has been mandatory to prevent any risks related to aspiration during anesthesia. When anesthesia is induced in patients, it inhibits the patients cough and swallow reflex posing a higher risk for the patient to aspirate any gastric contents. The gastric contents which are highly acidic can cause irritation and inflammation in the lungs which can hinder the gas exchange leading to imminent death of the patient (Andrew-Romit & Mortel, 2011). Therefore long fasting periods were always implemented to enable stomach emptying during the induction of anesthesia. However, current studies display a lot of information and evidence showing that pulmonary aspiration arises very rarely as a complication of modern general anesthesia (Gunawardhana, 2012).
Cardiac catheterization or coronary angiogram is one of the most common and minimally invasive procedures performed by a cardiology intensivist. Pre-procedure fasting or NPO has been the standard protocol of care since beginning due to the vomiting very commonly caused by the first generation of radio contrast materials which were nearly toxic in nature (Kern, 2010). However, the modern contrast media which is approved Food and Drug Administration (FDA) is much safer as various studies show very rare incidences of any adverse effects like vomiting, contrast related hypotension or arrhythmias (Kern, 2010). For a patient cardiac cath can be a nerve racking experience as it reveals any blockages in the coronary arteries which can be life changing for the patient and family. As nurses we are the gatekeepers of their fear and anxiety. The typical requirement of NPO past midnight increases the stress and anxiety in patients. NPO poses high risk for dehydration or even hypoglycemia in patients. Dehydration causes intravascular volume depletion which can in turn cause difficulty in accessing the artery for the procedure. It also puts the patient in high risk for contrast induced nephropathy (Rosengarten, Ozkor, & Knight, 2007). Keeping patients NPO for prolonged hours can cause numerous adverse effects like anxiety, irritability, confusion, dehydration, electrolyte imbalance, hypoglycemia, hypovolemia, nausea and vomiting etc. (Gunawardhana, 2012). This can create unwanted complications and prolong the length of stay in patients and also can adversely affect the patient satisfaction. Iowa model of evidence-based practice provided a comprehensive method to apply a structure to answer the resulting clinical question “In non-intubated and non- critical patients scheduled for coronary angiogram, will limited oral intake prior to coronary angiogram instead of “Nil Per oral” past midnight reduce patient discomfort and increase satisfaction?”

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