Preprocedure NPO in the ICU

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Depends upon how the pt is being fed....and how oversedated they are.....

----- Original Message ----- 
From: <cyberg66 at aol.com>
To: <trauma-list at trauma.org>
Sent: Saturday, August 22, 2009 4:49 PM
Subject: Re: Preprocedure NPO in the ICU


>
> As I read this I think about the number of times I've seen ICU nurses turn 
> off the tube feeds in a sedated/intubated ICU patient just because I laid 
> the patient flat for an exam or CVL placement. It always struck me as an 
> irrational act that decreased the patient's daily nutrition with no 
> marginal gain in patient safety. Is this a common practice? Am I crazy for 
> thinking that's a dumb thing to do?
>
>
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>
> -----Original Message-----
> From: Ian Seppelt <seppelt at med.usyd.edu.au>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Cc: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>; Trauma-List 
> [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Fri, Aug 21, 2009 10:08 pm
> Subject: Re: Preprocedure NPO in the ICU
>
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> ?
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>> We use a very similar protocol.  Patients are NOT starved before > 
>> surgery if there is a secure airway (ETT or trachy) unless there is > a 
>> surgical reason to starved (is emergency gut surgery). This is > 
>> particularly to avoid the prolonged starvation, that happens when a > 
>> 'booked urgent' case gets postponed. It makes no sense at all to > make 
>> intubated patients NBM (NPO). Talk to your anaesthetists.?
> ?
>
> Ian Seppelt, Sydney?
> ?
>
> ?
>
>>?
>
>> On 21/08/2009, at 6:45 PM, "Dr Timothy Hardcastle" 
>> <dr.tchardcastle at absamail.co.za> > wrote:?
>
>>?
>
>>> See blow:?
>
>>>> Might someone share their institutional policies regarding >>> 
>>>> preoperative?
>
>>>> NPO status constraints for ICU patients? In an attempt to maximize?
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>>>> nutritional therapy in our critical care population I would >>> 
>>>> appreciate?
>
>>>> some supportive materials to provide to the anesthesia and endoscopy?
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>>>> departments.?
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>>>>?
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>>>>?
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>>>>?
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>>>> Thanks!?
>
>>>>?
>
>>>> Cathy Dudick MD FACS?
>
>>>>?
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>>>> Harrah's Regional Trauma Center?
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>>>>?
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>>>> Atlantic City NJ?
>
>>>>?
>
>>>> --?
>
>>>> trauma-list : TRAUMA.ORG?
>
>>>> To change your settings or unsubscribe visit:?
>
>>>> http://www.trauma.org/index.php?/community/?
>
>>>>?
>
>>> Hi Cathy?
>
>>>?
>
>>> Based on our experience and the current nutrition / anaesthesia >> 
>>> literature?
>
>>> our policy is as follows:?
>
>>>?
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>>> For most of our patients feeding is into the stomach - NG tube. We >> 
>>> only?
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>>> feed post-pyloric if not tolerated X3 attempts.?
>
>>>?
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>>> For non-airway or abdominal surgery (read head, chest, orthopaedic?
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>>> procredures or radiology trips) feeding is NOT STOPPED at all in >> 
>>> patients?
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>>> with an ETT or trachy in situ.?
>
>>>?
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>>> For open tracheostomy, feeding is stopped 4 hours prior to >> procedure 
>>> and?
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>>> the tube is aspirated at the time of anaesthetic induction. Feeding >> 
>>> is?
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>>> recommenced immediately on arrival back in our unit.?
>
>>>?
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>>> For abdominal surgery feeding is stopped also four hours prior to?
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>>> procedure if definitive airway in place or 6 hours prior in >> adults / 
>>> 2?
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>>> hours prior in children who will require airway manipulation.?
>
>>>?
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>>> TPN if running is not stopped unless the patient becomes unstable?
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>>> intra-procedure.?
>
>>>?
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>>> There is evidence for all of this - mainly from the British and >> 
>>> German?
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>>> literature.?
>
>>>?
>
>>> Cheers?
>
>>> Tim?
>
>>> Dr T C Hardcastle?
>
>>> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)?
>
>>> Principal Specialist Trauma Surgeon /?
>
>>> Honorary Lecturer University of KwaZulu-Natal Dept Surgery?
>
>>> Deputy Director - IALCH Trauma Service?
>
>>> Durban - South Africa?
>
>>>?
>
>>> --?
>
>>> trauma-list : TRAUMA.ORG?
>
>>> To change your settings or unsubscribe visit:?
>
>>> http://www.trauma.org/index.php?/community/?
>
>>?
>
>> --?
>
>> trauma-list : TRAUMA.ORG?
>
>> To change your settings or unsubscribe visit:?
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>> http://www.trauma.org/index.php?/community/?
>
> --?
>
> trauma-list : TRAUMA.ORG?
>
> To change your settings or unsubscribe visit:?
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>
>
>
>
> --
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