NPO with no IV fluids?

[RVA Nurse]

I have a patient who was NPO after midnight including clear fluids (which I understand is controversial from an EBP standpoint). He's supposed to have an EGD with general anesthesia, but his IV fluids aren't ordered to start until he's admitted to endoscopy at 1pm. Is it normal to go 13+ hours without any kind of fluids?

I did some research, and all I could find was a fluid replacement algorithm, implying that it is normal, they just calculate his fluid deficit and give him a bolus. Also, it called to mind outpatient procedures, where they definitely don't have any IV fluids until admission, which I think is how they're treating it, even though he's inpatient on another ward.

I only have him until 8am, so I'm going to get an IV placed and let his daytime nurse talk to the doc and see if he needs early fluid replacement. What do you guys think?

[BonnieSc]

I've seen both, depends on the patient's condition. Healthy people can usually go without, and it avoids infection and limiting movement and fall risk. No harm in asking, and you're doing right not to call a doctor in the middle of the night for this.

[EricaAngela90]

Our doctors rational sometimes for certain procedures is that "He doesn't normally drink at home all night!" Also, "what if this patient was home the night before?"

[KatieMI, BSN, MSN, RN]

Yes, it is OK. Even people with full colon prep (which causes some net fluid loss) tolerate it well and for most of us it would be ok not to eat/drink anything from, say, 8 pm to 8 am, which is 12 hours.

Although, if you place a good IV, preop people will surely appreciate your help:yes:

[86711lh]

It also depends on the patient's condition like someone stated above. Never be afraid to ask the intern or residents. I don't know what kind of hospital you are in, but we had residents/interns 24/7 & to be honest sometimes they just forget to order them. I've had patients plenty of times who were NPO for a procedure with no fluids ordered & after paging an FYI like, "Mr. Doe is NPO after MN, but no fluids ordered" they ordered them. When I was a new grad I was always worried about paging & I would always ask someone else, like "hey should I page them about this" & the answer was ALWAYS yes.

At the end of the day your job is to act in the patients best interest and if you think something isn't right or an order is wrong & you don't say anything it doesn't matter if the doctor didn't order it, you'll be the one getting the backlash. Like they always say, the minute something goes wrong, if you don't have your stuff together you will be the one to get thrown under the bus, so always cover yourself as well.

[CT Pixie, BSN, RN]

As others have said, sometimes they get fluids and sometimes not. It depends on the patients status.

I will ususally page them with a quick text saying much the 86711lh said, 'NPO after midnight. no fluids ordered, would you like to order them?'

often within minutes I see an order for fluids to be started, other times I get the 'thanks for the heads up, but no fluids at this time'

Most of my patients are relatively healthy and really don't require fluids. Like the others said, if they were home the night before their surgery, they wouldn't be drinking anyway since they'd be NPO.