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CS165
NPO at Midnight: A Practice Based on Tradition or Science
By: A.R. Leasure, C. Thompson, D. Barnard-York, J. Stirlen, E. Kodumthara, G. Freeman, & S.G. Davic; University of Oklahoma Health Sciences Center, OU Medical Center, Department of Veterans Affairs Medical Center, Oklahoma City, OK
For further information, please contact: renee-leasure@ouhsc.edu
Purpose: The era of evidence based practice has afforded clinicians the opportunity to examine the theoretical underpinnings of many traditional practices. One such practice is that of the standard order of “NPO after Midnight” for preoperative and preprocedure patients.
Description: Critically ill patients are particularly vulnerable to malnutrition during a time when adequate nutrition is of paramount importance. Minimizing preoperative fasting times is a low cost intervention which can decrease postoperative insulin resistance rates. Aspiration risks are increased not by the volume of oral fluids ingested prior to surgery but rather by the type of fluids ingested, the choice of anesthetic agent, and difficult intubation. Carbohydrates leave the stomach more rapidly and protein and much more rapidly than fat which is the slowest to leave the stomach. Thus clear liquids may be taken up until two hours before surgery. This in turn results in decreased rates of post-operative nausea and vomiting. In order to reduce aspirations during intubation, at risk patients for difficult intubation were identified with a green arm band and a green medical record label. A difficult intubation tray was assembled and available in the ICU’s as well as a difficult airway team. Post pyloric feeding placement was encouraged. Post pyloric tubes offer the opportunity to both help meet the caloric needs of the critically ill patient and also to reduce ventilator associated pneumonia rates due to aspiration.
Evaluation and Outcomes: Outcomes, which are being tracked with implementation of these practice changes, include post-operative aspiration pneumonia rates, infection rates, insulin resistance rates, and patient satisfaction. Today’s evidence focused environment, provided a stimulus for a multi-institutional based group to examine traditional practices and make evidence supported changes in order to improve the care of critically ill clients.
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