Pre Procedural Diet and Nutrition Guidelines for Patients Undergoing Coronary Angiography and Angioplasty

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1 Pre Procedural Diet and Nutrition Guidelines for Patients Undergoing Coronary Angiography and Angioplasty Written by: Dr Ferrah Choudhary (Cardiology SpR) Approved by: Dr Harcombe (Consultant Cardiologist), Dr Smith (Consultant Cardiologist), Dr Varcoe (Consultant Cardiologist), Deputy Sr Julie Taylor (Sister CSSU), Julia Ivanova (Deputy Sister Cath Lab) on 25 th April, 2014 at Departmental PCI Meeting. Re approved at: Interventional Meeting 13 th May, 2014 by Consultant Cardiologists: Dr Harcombe, Dr Jadhav, Dr Henderson, Dr Ahsan and Dr Varcoe Special Contribution by Sister Jane Quinn who undertook NBM policy audit Implementation Date: 20 th October 2014 Review Date: 1 st October 2020 Introduction: The practice of pre operative fasting prior to surgery and other procedures aimed to reduce gastric volume and acidity. This was felt to prevent subsequent regurgitation and aspiration of gastric contents. However, recent evidence has shown that pre procedural fasting has been deemed unnecessary and can cause adverse events such as hypotension, anxiety, dehydration, biochemical imbalance, contrast induced nephropathy and hypoglycaemia. There has also been evidence to suggest that prolonged fasting can cause gastric volume to increase, leading to a greater risk of aspiration. There is limited evidence based research to support pre procedural fasting prior to coronary procedures. There is no clear evidence of benefit in keeping patients NBM. Standard practice has traditionally been to keep patients NBM for 4 6hours prior to a cardiac procedure in order to minimise the risk of aspiration pneumonia, especially in those patients who may require emergency surgery or general anaesthesia. No clear guidance currently exists in this field.

2 A recent study published in Heart in February 2014 concluded that coronary interventional procedures can be safely performed without the need to keep patients NBM. This document replaces all previous fasting guidance and is to be used to guide the production of: Patient information leaflets Interventional Cardiology Care Pathway Additional Care Protocols Guidance for all staff performing pre operative assessments Protocol: All patients attending for Coronary Angiography or Angioplasty should be allowed to drink clear fluids and have a light breakfast or lunch according to the criteria below: Light Breakfast : Cereal or Toast Light Lunch: Sandwich or Salad Prescribed Medications: Prescribed medications, especially pre medication can be taken prior to the procedure with a small drink of water. Certain medications may require omission prior to the procedure as a result of specified instructions or established guidelines (eg; warfarin and metformin). Analgesic drugs should not normally be omitted as pain may prolong gastric emptying times and lead to agitation and pain during the procedure. Exceptions: Patients with Diabetes Mellitus should have regular blood glucose monitoring and dietary intake should be adjusted according to their blood glucose levels. It is pertinent to remember that diabetic patients may have prolonged gastric emptying times due to autonomic neuropathy. Diabetic patients should be given their normal medications (with the exception of metformin and see below for details regarding insulin dosing) and be

3 allowed to eat and drink as per protocol (eg; light breakfast/lunch) with close blood glucose monitoring. Patients on insulin therapy should be given their normal insulin on the day of the procedure along with a light breakfast/lunch as per the usual protocol. It is important to ensure regular blood sugar monitoring on a one hourly basis and adequate fluid replacement is given (orally or intravenously) to prevent dehydration. Standby Patients: All patients that are of standby status at the end of a list should be prepared as though they will be having the procedure on that day. They should also be given a light breakfast or lunch and drink normally. Please note: A consultant may choose to fast a particular patient if they are felt to be at increased risk of aspiration, this will be indicated on the pink referral form or NOTIS referral.

4 References: 1. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures Anesthesiology 1999; 90: Pre-operative assessment, the role of the anaesthetist. Association of Anaesthetists of Great Britain and Ireland November Preoperative fasting for adults to prevent perioperative complications. The Cochrane Database of Systematic Reviews 2003, Issue 4 4. Perioperative fasting in adults and children an RCN guideline for the multidisciplinary team. RCN publications November Hamid et Al. Pre-procedural fasting for coronary interventions: Is it time to change practice? Heart 2014; 100: Surgery and Diabetes - Guidelines on Glycaemic control. Trust Document HMR Pre-Operative Fasting Guidelines - %20Pre%20Operative%20Fasting%20Guidelines%20final%202.pdf

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