fasting and cardiac caths

[Glenn Murray]

I would appreciate peoples thoughts around fasting patients for cardiac catheterisation. We currently allow a light breakfast.

We had problems with people being fasted from midnight then having their case pushed back resulting in episodes of vasovagals and potential problems of dehydration and contrast. I suppose our problem is that most of our cases may be plus or minus PTCA, depending on coronary pathology, and case times can be thrown out resulting in patients fasting for longer than anticipated.

What are some of the fasting policies out there? Would appreciate your comments.

[dianah, ASN]

If the pt will receive sedation (and most do), you must abide by your facility's moderate sedation protocol. Ours is: NPO solid foods 6-8 hr, may have water up to 2 hr pre.

Years ago, the contrast used would often (~30% of the time) cause vomiting, so fear of aspiration (the pt is flat on his back!) AND need for hydration were both important reasons to withold food/fluids the appropriate, SAFE time. The newer contrast agents (nonionic, some are iso-osmolar) have GREATLY reduced the amount of related vomiting. However, I still have seen it happen, and for that reason and the sedation itself, the protocol stands -- for patient safety.

What may help (and we're still trying to educate the Residents about this) is orders for pre-hydration. This is important if pts are NPO after midnight, and ESPECIALLY as they will be receiving iodine contrast. Their kidneys must be protected by prehydration and, in some cases, premedication with mucomyst and/or a bicarbonate infusion pre- and intra-cath. One of our Cardiologists orders 500ml bolus for all out-pts in the hour or two (or longer) they're in the Short Stay Unit, before they come up for their cath. We only do diagnostic caths but we pay attention to how much contrast we give, as we may have to send the pts off for a PCI (Percutaneous Coronary Intervention = angioplasty/stent), where more contrast will be used. Protect the kidneys!

Our schedule in our lab is so variable; the Cardiologists triage the add-ons, but between one delay or the other (some have abnormal anatomy and it takes a lot longer to place the catheters where we can get diagnostic images), SOMEONE always ends up waiting longer than anticipated for his/her procedure. Hopefully your cath lab stays in touch w/you, so you can inform the pts of delays and obtain necessary orders if the pts don't have any fluids infusing.

You're to be commended for considering this very important issue! Your patients are lucky to have you as their nurse. :)

[Pill Hoarding Hussy]

at my hospital all of our pre-cath pt's are npo from mid noc for the reasons the above poster stated. we preh-hydrate almost all of them and use bicarb gtts and mucomyst for CRI/RF pt's. we do give most am meds with h2o before sending them though. we try to hydrate failure pt's gently.

it's a large teaching facility with fully operational ccl, so there's always the chance of long interventions pushing back the schedule. we try to keep the fasting pt's on bedrest. hope this helps.