NPO after VAP insertion?

[brownbook]

In our out patient clinic we do VAP (venous access port) insertions. Sometimes 3 - 4 a week, sometimes 3 - 4 a month.

Gradually, with no doctors orders, nurses started deciding on their own nursing judgement to keep the patients NPO in recovery until confirmation, via chext x-ray, of their VAP placement (re: no pneumothorax, etc.) This confirmation takes from 15 -30 minutes.

It drives me crazy, just one of my bug-a-boos, nurses sometimes want to make things more complicated, more "intensive care" than they need to be. I give my patients the usual juice and crackers and sometimes have their IV out and they are dressed and ready to go home even before the x-ray confirmation. Not that I want to rush them out the door, I base it on they and their family want to leave ASAP.

I stopped one of our anesthesiologists in the hallway once and asked him. He said no, they do not need to be NPO, even if they needed a chest tube they would not need to be NPO for that. Once, over 5 years ago, a patient had a small pneumothorax, we repeated the x-ray about an hour later, it was already resolving, and sent the patient home.

I hesitate to ask our chief anesthesiologists because he is less easy going that the one I stopped in the hallway. I'm afraid I will be told, well yes, it is probably a good idea, not based on evidence just a kind of yeah maybe probably.

Just curious what other All Nurses think of this?

[prmenrs, RN]

Your judgement may be correct, but try to find some "evidenced based" back-up. Everybody needs to be on the same page. If there's nothing in your P&P, talk to the nurse educator or manager about getting it in writing.

I'm not saying merely "go w/the flow", but if everyone else is going right and you are going left, something needs to be reassessed.

You might start w/finding out what similar institutions in your community are doing.

[Esme12, ASN, BSN, RN]

Just in case of the horrible and they would need to go to the OR again. Grant it, it's rare.....you are increasing their chance for complications. I mean, 15 minutes isn't that long. I'll bet if that patient has to go back to the OR and they aspartate anesthesia and the surgeon won't be so understanding and will want to know why you fed them before confirmation.

I had a code once.....it was a pacer insertion and when they sat the patient up for his CXR.....he coded from perforation of the right ventricle and had to go for repair. Isolated but very real.

A once of prevention is worth a pound of cure. I would also check to see what the actual policy is and follow it then I would approach the manager to see if you can investigate about changing it with some real evidence based material.

Good luck

[Altra, BSN, RN]

The procedure is not without risk - you can ask the patient whose aorta was nicked during a subclavian port insertion.

NPO, and maintenance of peripheral IV access are easy safety measures until you have CXR confirmation of correct placement.

[brownbook]

There is no policy and no written or verbal orders from surgeons or anesthesia to be NPO.

I do appreciate your cautionary tales.

I will have my patients in bed, NPO, with their IV, and their families waiting, until we get their c-x-ray confirmed.

[Esme12, ASN, BSN, RN]

There is no policy and no written or verbal orders from surgeons or anesthesia to be NPO.

I do appreciate your cautionary tales.

I will have my patients in bed, NPO, with their IV, and their families waiting, until we get their c-x-ray confirmed.

These are NOT cautionary TALES.....but real life complications that although rare can occur. You don't need a MD order for NPO if it is usual and customary and standard of care.You will be held to the "standard of care" that another "prudent nurse" would practice. I'm glad you are listening to the experiences and rationale of experienced nurses. :loveya:

[GitanoRN, BSN, MSN, RN]

needless to say, i agree with all previous post, and lastly remember...it's better to be safe than sorry~

[Creamsoda, ASN, RN]

I personally err on the cautious side. whats 15-30 minutes for the patient. Its safer for them if something happens to be NPO until confirmed.