NPO Status for Cath Labs: Letters to the Clinical Editor
Dear Dr. Kern,
I read your article “Should NPO be the Rule Before Cath?” (CLD Oct 2010) with great interest. As the service line educator for the heart and vascular center at our institution, I recently spent a great deal of time developing a diabetic protocol. The protocol allowed our RNs to practice within scope in the advising of diabetic patients on their need to adjust diabetic medications in relation to their NPO status pre procedure. Certainly, avoiding the NPO status would have solved many of these issues and this is something I will bring forward at our next CV council meeting. I am writing, though, to ask about your comment regarding the avoidance of hyperglycemia episodes by avoiding NPO orders. Our issue was with hypoglycemia, not hyperglycemia, as patients were getting instructions to be NPO, but not appropriate instructions on holding or decreasing their medications. How does hyperglycemia figure into the diabetic patients who are being made NPO?
Lynne “Scotty” Maccubbin, RN
Service Line Educator, Heart & Vascular Center/Procedures
Yale New Haven Hospital, New Haven, Connecticut
Dear Ms. Maccubbin,
Thanks for your comments and question regarding hyperglycermia in NPO diabetic patients. Most of the concern prompting NPO was stomach contents and what will happen when nausea and vomiting occur. For NPO, little consideration was given to regulating glucose except to instruct patients to cut their insulin dose in half. I have not seen nor read about problems of hyperglycemia after cath since this problem is usually easily treated with another shot of insulin and then reinstituion of their diabetic regimen. As Dr. Bittl stated, most of the time, the sickest patients are the STEMI patients who are not NPO, and all that we really do with NPO is dehydrate them and make it more likely that acute kidney injury can occur.
I recommend discontinuing the NPO policy and have clear liquids for breakfast before the procedure.
Morton J. Kern, MD
Dr. Kern can be contacted at firstname.lastname@example.org.