My patient aspirated during surgery!

[SweetNothings]

I am so distraught right now. I just got a phone call from a dayshift nurse stating that the patient I sent to surgery this morning aspirated during her procedure from what appeared to be a full stomach. My patient had been NPO since midnight. She was oriented and aware of this and all food/drinks were taken away from the bedside. She was not able to get out of bed and she had no vistors during the night, so there was no way (that I know of) that she could have snuck food. I immediately called my manager and notified her of this. She said that she would let the OR know, but I am sick with worry. How could this have happen? I am so worried about the patient and that I may lose my job. I just don't know what to do. Should I call my manager back again?

[StrwbryblndRN]

You did what you could. If for some reason she had someone bring her something and she knew better, then so be it. It does not always make it easier but you know that you did nothing wrong.

[canesdukegirl, BSN, RN]

If the pt was NPO and you noted this in your pre-op checklist, you should be fine.

There are a myriad of reasons as to why gastric contents aren't emptied normally.

Don't worry yourself too much about this.

[Penelope_Pitstop, BSN, RN]

I don't know the details of the event, but I do know this...

this patient was alert and oriented and knew full well that she was not to have eaten, right?

If she did eat or drink before the surgery, sadly that was a choice she made. You did all that you could to prevent this.

Also, during the pre-operative period, patients are asked about their last intake. Had she said, "oh, I ate breakfast." the anesthesia time more than likely would have not gone through with the procedure. If she did say that and they proceeded anyway, I hope they explained to her the risks involved. If she lied to them, well...why would the team not believe her.

Obviously there is more going on that you don't know about, and it's not any of your fault.

I hope your patient turns out okay.

[SweetNothings]

Well, I just talked to my manager again. She said my pt was fine and had her surgery. She said she aspirated on what appeared to be a small amount of fluid and not a stomach full of food like they told me. She will be back to the floor this evening. Thank God.

[maelstrom143]

Also may be due to undiagnosed delayed gastric emptying? Just a thought. I have gastroparesis and that makes it necessary to intubate me for procedures, as food I may have eaten yesterday may still be in my stomach (even had the discomfort of feeling as if it was going bad...eeewww) so am considered higher risk.

If she did eat/drink w/o regard for her own safety and lied about it, that is not your fault. You are her nurse, not her babysitter. I feel bad for her, but people need to take responsibility for their actions. Good luck and best wishes for a good outcome, both for you and your patient! :hug:

[Horseshoe, BSN, RN]

Well, I just talked to my manager again. She said my pt was fine and had her surgery. She said she aspirated on what appeared to be a small amount of fluid and not a stomach full of food like they told me. She will be back to the floor this evening. Thank God.

Glad to hear that. I would certainly (calmly and not accusingly) ask the day shift nurse how "a small amount of fluid" got translated into a stomach full of food. Sheesh.

[Snowbird17]

I guarantee that if this patient was AAOx33, the anesthesiologist asked her if she had anything to eat or drink. They would not intubate her without asking. So either she said NO and they proceeded, or they forgot to ask.

Either way you are not responsible. Sounds like the day shift nurse was a little dramatic, and may have well given her the fluid. Often I will give patients their AM meds with a few sips. So she may have felt responsible and was shifting blame. Regardless, the patient is back on the floor so the aspiration must have been very minor.

You will walk away a better nurse because in the future you will be more aware of keeping patients NPO pre-op as well as documenting it!

[canesdukegirl, BSN, RN]

Oh honey, I am so glad things turned out ok. :)

[psu_213, BSN, RN]

I guarantee that if this patient was AAOx33, the anesthesiologist asked her if she had anything to eat or drink.

That is someone who is in touch with her world! (sorry, I coult not resist).

Anyway, when I have taken a pt down to preop holding, they anesthesiologist, the preop nurse (and sometimes one or two other people) all ask the pt "when was the last time you ate?" At that point, the unempty stomach falls on the OR folks and the pt, not you.

In addition, if it was charted that they were NPO all night, they were indeed held NPO all night, they had no apparent access to food/drink, and all this was charted, it should not fall back on the OP.

[wooh, BSN, RN]

AAOx33! hehe! psu is right, that is an ALERT and very ORIENTED patient!

Reminds me of all the times I'd be going over an admission on an infant that would have their mental status as "alert and oriented to person, place, and time."

[diva rn, BSN, RN]

AAOx33! hehe! psu is right, that is an ALERT and very ORIENTED patient!

Reminds me of all the times I'd be going over an admission on an infant that would have their mental status as "alert and oriented to person, place, and time."

and that reminds me of the time a doctor wrote on an admission form (which he hated to fill out) under address...he lives in the nursery because he was just born!