NPO before surgery is nonsense

Specialties Operating Room

Published

.....or, maybe it isn't. I figured I'd ask those of you that know.

How long does it take for a couple of ounces of water to be absorbed? what is the possible hazard of a pt drinking a little water a couple hours prior to surgery?

As an ER nurse, I keep my pt's NPO when ordered, but don't really know why. I get why they shouldn't have a cheeseburger and milkshake, but ice chips?

It feels like surgeons don't trust pts, or nurses, for that matter, to follow instructions.

For example: pt A and pt B are both scheduled for surgery tomorrow. A at 0600, B at 1100. Both are NPO after midnight. At 1130, pt A has a huge meal. At 0500 pt B would like some water, but can't have any.

Can somebody please explain the physiology here?

hherrn

Specializes in Critical Care.
janfrn said:
That would be a LOT of gastric secretions in a 3 kg infant... But point taken.

I was speaking of an adult, true.

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Specializes in Recovery (PACU)-11 yrs, General-13yrs.

Why do some think that NPO, or NBM (nil by mouth is the term used in Australia) exlcudes water-nothing to eat or drink means NOTHING TO EAT OR DRINK.

I was looking after a post-op pt with an LMA in, when blue water burbled up through the tubing-he had had a blue coloured boiled lolly/sweet/candy (use nationally appropriate expression) a couple of hours pre-op, he thought it didn't count!

And through all the checks of "when did you last have something to eat and drink?" he felt it wasn't worth mentioning. First question I asked when he was awake was "what did you have that was blue" Luckily he didn't aspirate, dread to think what it could have done-mint and sugar and stomach acid. And he was AOx3, mid 40's for elective surgery-no excuses at all, apart from the fact that he knew better than the anasthetist whose skill & knowledge he was paying a fortune for.

He did learn that nurses always find out the truth in the end!

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We follow the NPO after midnoc. Allowable is a sip of water with essential meds in am. For more urgent cases we go with 6 hours NPO. Emergent cases get a "crash" induction. When I had surgery a couple of years ago, it was scheduled for 2pm and I was allowed clear liquids til 6 am. I was grateful.

Early in my career, I asked a 6yo T&A patient what he had for breakfast and he told me cereal and juice. I looked at mom & dad and sure enough, they said junior had been up before them and it was possible. Surgery cancelled and I now ask all children what they had for breakfast. Have gotten this type of answer several times over the years.

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Specializes in NICU, PICU, PCVICU and peds oncology.

My last two surgeries were later in the day, one at 1300 and the other at 1630. I was NPO at midnight for both. I wonder how much that has to do with the degree of post op N&V I always have.

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So-

Back to one of my questions?

Anyoone know how long it takes a few ounces of water to be absorbed on an empty stomach? Minutes?

hherrn

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Specializes in surgical, emergency.

I tried to look around and find an answer to how long it takes fluid to leave the stomach, and couldn't find an exact answer. It depends I guess......just plain water would either be absorbed or empty out rather quickly under normal situations. My best guess from what I read is about 50% could be gone in 30 minutes or so.

That said....there are many variables.

Milk, etc would take longer, since the stomach would hold it to start the digestion process...food even longer.

Keep in mind that different people's emptying rates would be different, if they had problems such as a hiatal hernia, that would also change things.

In trauma situations, pretty much all of our pt's are considered full stomach. The digestion process stops at the time of the injury. People always seem to get injuries right after a full lunch!!!!

Anyway, one of the anes. docs was telling me the other day, that they are (or have) revisited their standards, and clear liquids up to a couple hours of some procedures is gaining acceptance.

I don't have any of the exact numbers, wish I did, but it's not always the midnight cut off any longer.

As others have noted, pt's can't always be trusted. It's that "give an inch, take a mile" attitude.

Americans in general, it seems to me, are not too good at accepting directions, especially if it's inconvenient in any way!

Remember, for the most, we are talking about elective surgery here! Is it really worth the chance??

Mike

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Specializes in Operating Room (and a bit of med/surg).

We have NPO at MN guidelines, but allow clear fluids in the morning for late-booked cases. (When they have their pre-op visit they are advised on the cut off time). It is amazing to me how many people can't/don't/won't follow guidelines. And how if you ask the question just a little differently you get a different answer.

I've had a patient IN the OR, about to get on the table... "When's the last time you had something to eat and drink?" "I had a little snack in pre-op". Don't ask me how the patient got ahold of our cookies, but she'd had 3 packs (6 cookies) about 2h ago. She got hungry so she didn't think it would matter. (cuz if you're hungry you won't aspirate?? So we postponed her surgery, had to tear down the whole room (cuz she'd been in the room), and turn over to do the next case. What a waste.

Another good reason for a broad "NPO @ MN" is that surgery times can change very quickly. Say your 5h 8am case is cancelled. Well, better move all those other cases up. Oops, your 1300 pt is not NPO until 6am?? Not a good situation.

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I'm a patient that is going to have a stent installed in my renal artery tomorrow. I totally understand the reasoning for NPO after midnight for most surgeries, but mine makes no sense to me. I'm not going to be intubated, and I had a renal angiogram done a month and a half ago and I was wide awake the whole time and it was a piece of cake. I went through considerable misery (by not eating) for nothing. What the radiologist and nurses don't understand (because they never ask) is that because I'm a recent renal xplant patient, the Cellcept I'm taking makes me take a bowel movement as soon as I eat in the morning, and if I don't eat breakfast, I'm very liable to have a BM during the stent procedure, or during the six hour period that I will have to lay flat on my back after the procedure. So I've made the decision to eat a light breakfast at 4:00 AM, which will allow me to go ahead and have a BM, and I just won't tell the doctor. I hate doing that, but nobody ever understands that the Cellcept is calling the shots here, not me or the doctors. That's just the way it is. The way I see it, the risk of complications from having to get out of bed and take a BM when I'm supposed to be on my back so that I don't bleed after the procedure is a far higher risk to my health.

Any thoughts from anybody?

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

About four or five years ago the hospital where I work did away with NPO for surgery. It goes like this, clear liquids only 8 hours before surgery, then only small sips of water in the two hours before surgery.

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Specializes in NICU, PICU, PCVICU and peds oncology.

You have absolutely no way of knowing if you're going to end up intubated or not. And guess what... we have ALL cleaned up patients who have soiled the bed, for whatever reason. HOWEVER... this is not the forum for seeking medical advice, which is essentially what you're doing. Good luck with your procedure.

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Specializes in NICU.

I was an inpatient scheduled for surgery at 1300. My surgeon told me I could have something to eat at 0400, then NPO. I requested a grilled cheese sandwich (we had 24 hour food service), which was great because my surgery started about 3 hours late. If I had not eaten I would have been a very unhappy patient by then.

BTW, vets allow pets water all night, just no breakfast in the morning before surgery.

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Specializes in OR.
samta69 said:
I'm a patient that is going to have a stent installed in my renal artery tomorrow. I totally understand the reasoning for NPO after midnight for most surgeries, but mine makes no sense to me. I'm not going to be intubated, and I had a renal angiogram done a month and a half ago and I was wide awake the whole time and it was a piece of cake. I went through considerable misery (by not eating) for nothing. What the radiologist and nurses don't understand (because they never ask) is that because I'm a recent renal xplant patient, the Cellcept I'm taking makes me take a bowel movement as soon as I eat in the morning, and if I don't eat breakfast, I'm very liable to have a BM during the stent procedure, or during the six hour period that I will have to lay flat on my back after the procedure. So I've made the decision to eat a light breakfast at 4:00 AM, which will allow me to go ahead and have a BM, and I just won't tell the doctor. I hate doing that, but nobody ever understands that the Cellcept is calling the shots here, not me or the doctors. That's just the way it is. The way I see it, the risk of complications from having to get out of bed and take a BM when I'm supposed to be on my back so that I don't bleed after the procedure is a far higher risk to my health.

Any thoughts from anybody?

You're playing a risky game there. You might not think you will be intubated, but things can happen during a procedure, and no one knows for certain. Patients have BMs during procedures. It happens. We don't complain about it, its part of the job. We clean the patient and move on. No big deal. BUT if you need to be intubated for some unforeseen reason, and no one knows you ate, you are at a MAJOR risk of MAJOR complications. Far more disastrous than having a BM in bed. They do have bedpans, not an ideal way to have a BM, but a viable option in the short term. But it sounds like you have decided to take matters into your own hands and ignore the instructions of your physicians/care providers. Just please don't turn around and sue your physicians/care providers because you thought you knew more than they did and ignored their directions and have a bad outcome. I hope for your sake things go well and are uneventful. But you are playing a risky game.

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