grrrrrrrrrr......... - page 6

:madface: :madface: My dad is in the hospital and is getting IV antibiotics...the cannula became dislodged, so he needed a new IV. This "nurse" (and I use that title loosely with this person) came... Read More

  1. by   Marie_LPN, RN
    We only drop an NG on emergent cases when someoen ate recently (i.e. MVA that occured on the way home from dinner). One rationale i've heard from an MDA is that letting the stomach empty on it's own is better than suddenly sucking out the contents (that's what HE said, i'm just offering it as an idea of why, and not as an arguement).
  2. by   catlady
    Quote from Marie_LPN
    We only drop an NG on emergent cases. One rationale i've heard from an MDA is that letting the stomach empty on it's own is better than suddenly sucking out the contents (that's what HE said, i'm just offering it as an idea of why, and not as an arguement).
    Oh, I agree, too, that you wouldn't want to drop an NG on everyone. But if you have an emergent case and you know the patient just sucked down a Big Gulp, you might possibly think about it. But I don't know; I admit I haven't done the research. I do agree with the previous poster who said that sometimes people keep getting made NPO for days at a time because nobody's paying attention. First it's for a diagnostic, then it's for a procedure, then it's for a surgery that might or might not happen. Before you know it, they're nutritionally depleted and the docs wonder why they aren't healing up so well from that surgery.
  3. by   ortess1971
    Quote from caroladybelle
    Evidence based research has identified a only short period of true NPO before most surgeries is adequate for prevention of aspiration in most cases. Depending on the researcher and study, most patients may safely have clear fluids until about 3-6 hours before surgery. Solid food is withheld from 6-8 hours. For children/babies the time periods of NPO may be lower.

    Again, as in the prior post, some bowel procedures and some patients may require more time, due to other medical issues. And people can aspirate on fluids produced in the gastric track, even if they have been NPO.

    This post was not to say to completely disregard orders for NPO, but that they are not necessarily as strict as previously believed. Often MDs will permit a "light breakfast" and nurses will make the patient NPO, because of a previous practice that has been proven to be incorrect.

    Now many surgeons like to play the fitin game, of let's make the patient NPO every morning for several in row, "just in case" they can get a procedure in early. That is not always in the best interest of the patient's overall health.
    I figured you meant that they shouldn't be completely disregarded. My one pet peeve, though, are patients coming down to the OR not adequately prepared for surgery(not being kept NPO), coming from the ER dressed and being told by the nurses there that they could keep their underwear on for abdominal surgery:uhoh21: etc etc. With all due respect, its not the nurses call as to who should be NPO or not. That's the doctors call and quite frankly, I'm going to trust anesthesia on this one. I have assisted in intubating someone who had "just a few sips" of liquid and it does make the whole process trickier. My "evidence based practice" is what I see and I've seen aspiration-it ain't pretty. It's not fun to be NPO but I'll take that over spending time in an ICU because myself and/or the nurse thought we knew better than the people who intubate patients on a daily basis. Just my 2 cents.
  4. by   Marie_LPN, RN
    I've seen disasterous results from "NPO fibbers" and "just a sip or two" as well.
  5. by   catlady
    How do y'all feel about "NPO except meds," which of course requires sips of H2O?

    I think this is a really interesting subtopic. I might use it when I have to pick a research topic for school. I'm learning a lot right now.
  6. by   Marie_LPN, RN
    Quote from catlady
    How do y'all feel about "NPO except meds," which of course requires sips of H2O?

    I think this is a really interesting subtopic. I might use it when I have to pick a research topic for school. I'm learning a lot right now.
    Should be done with as little of water as possible.
  7. by   caroladybelle
    Quote from ortess1971
    With all due respect, its not the nurses call as to who should be NPO or not. That's the doctors call and quite frankly, I'm going to trust anesthesia on this one. I have assisted in intubating someone who had "just a few sips" of liquid and it does make the whole process trickier. My "evidence based practice" is what I see and I've seen aspiration-it ain't pretty. It's not fun to be NPO but I'll take that over spending time in an ICU because myself and/or the nurse thought we knew better than the people who intubate patients on a daily basis. Just my 2 cents.
    And my research is from the Department of Anesthesia at Johns Hopkins - conducted by anesthesiologists (not by nurses/plain MDs) - you can review it yourself on the website. in fact, if you use google, the vast majority anesthesia departments agree that based on facts and percentages of surgical related aspiration, there is NO statistical advantage re: aspiration episodes or complications between regular patients (barring certain comorbidies, clearly delinated in the studies) being completely NPO 8-16 hours and those that were merely off solid food (limited clear fluids permitted) for 6-8 hours and NPO for 3-4 hours prior to surgery.

    Interestly enough, in one study done by an anesthesia department (not JHUH), there were no cases of aspiration in either group, less or more restrictive fasts. However, the group that had the stricter fast (8-16 hours of strict NPO) had substantially more vomiting after surgery than those with less restrictive fasts (clear fluids up to 3 hours preop and light solids up to 8 hours prior).

    These are studies that have been done at numerous facilities and has consistantly demonstrated the safety of this within certain guidelines.

    Again, aspiration can occur even in patients that have been NPO for days. But data clearly indicates that there is no difference in the numbers.

    While we can all relate to the unforeseen happening (especially with 9/11 at our heels), and we all can tell stories about this, that and the other that happened because of....., we need to start encourage practices based on research and proven ideas. And while we cannot change anesthesiology practices in our hospitals, we can be accepting of practice change when it is accompanied by well documented evidence.

    Again, I never claimed to know better than "the doctor"....this is research done BY THE ANESTHESIOLOGISTS...the doctors themselves. I like to think that maybe they do know what they are doing.
    Last edit by caroladybelle on Sep 10, '06

close