Preoperative Fasting Policy for Adults and Children

Transcription

1 Preoperative Fasting Policy for Adults and Children Type: Clinical Guideline Register No: Status: Public on ratification Developed in response to: Clinical Need Contributes to CQC Regulation 9,11 Consulted With Post/Committee/Group Date Ben Maddison Consultant Anaesthetist, Preassessment Lead 18th November 2015 Joseph Hussey Consultant Anaesthetist, Paediatric 18th November 2015 Anaesthesia Lead Samantha Brayshaw Consultant Anaesthetist, Obstetric Anaesthesia 18th November 2015 Lead Rebecca Martin Consultant Anaesthetist, Burns ITU Lead 18th November 2015 Sarah Everett Lead Nurse Anaesthetic Assessment Unit 18th November 2015 Dawn Little Lead Nurse DSU 18th November 2015 Professionally Approved By Christopher Wright, Clinical Lead Anaesthetics 18th November 2015 Version Number 1.1 Issuing Directorate Anaesthetics Ratified by: Document Ratification Group Ratified on: 7 th December 2015 Executive Management Board Sign Off Date December/January 2016 Implementation Date 15 th December 2015 Next Review Date November 2018 Author/Contact for Information Sofia Huddart, Clinical Fellow, Anaesthetics Policy to be followed by (target staff) All relevant clinical staff Distribution Method Intranet & website Related Trust Policies (to be read in conjunction with) Pre-operative Preparation Policy, Reducing Fasting Times for Adults and Children Requiring GA or Sedation in Burns ITU Document Review History Version Number Brief Reason for Update Authored/Reviewed by Active Date 1.0 Dr Sofia Huddart November Updated paragraphs 3.2, 5.5, 5.9, 5.10, 7.2, 8.2 Dr Peter Thomas October 2017 Index 1

2 1. Purpose 2. Equality and Diversity 3. Scope 4. Staffing and Training 5. Fasting Guideline 6. Breach reporting 7. Audit 8. References 2

3 1 Purpose 1.1 To define the preoperative fasting protocol for adult and paediatric patients undergoing procedures under general anaesthesia, regional anaesthesia and sedation i.e. monitored anaesthesia care based on current recommendations. 1.2 Preoperative fasting is intended to reduce the risk of pulmonary aspiration of gastric contents the complications of which are aspiration pneumonia, respiratory disability and related morbidity and mortality 2 Equality and Diversity 2.1 The Trust is committed to the provision of a service that is fair, accessible and meets the needs of all individuals. 3 Scope 3.1 This document applies to all adult and paediatric patients undergoing monitored anaesthesia care in the Trust. 3.2 These guidelines are based on the most recent recommendations of the American Society of Anaesthesiologists (ASA) 2017 guideline and the European Society of Anaesthesiology (ESA) 2011 guideline 4 Staffing and Training 4.1 This guideline is intended for use by all healthcare workers involved in the care of patients undergoing monitored anaesthesia care. 5 Fasting guidelines 5.1 Adults: 6 hours before anaesthesia for solid food or enteral feed 2 hours before anaesthesia for clear fluid 5.2 Infants (age less than 2 years) 6 hours before anaesthesia for infant formula, cow's milk, solids or enteral feed 4 hours before anaesthesia for breast milk 2 hours before anaesthesia for clear fluids 5.3 Children (age between 2 and 16 years) 6 hours before anaesthesia for formula, cow's milk, solids or enteral feed 4 hours before anaesthesia for breast milk 2 hours before anaesthesia for clear fluids 5.4 Obstetric Patients As for adults for elective procedures Clear fluids should be encouraged in labour 3

4 5.5 Plastic Surgery Hand Trauma Patients & Elective Hand Patients For operations planned as regional anaesthesia only Clear fluids allowed up until patient leaves ward for theatre 5.6 For the purposes of these guidelines clear fluids constitutes fluid through which print can be read and does not contain alcohol or milk. It includes black tea and coffee, pulp free fruit juices, fizzy/carbonated drinks and carbohydrate-rich drinks. 5.7 Chewing gum and boiled sweets are allowed up to 2 hours before anaesthesia. After this point they should be removed to prevent oral retention on induction of anaesthesia. 5.8 However, patients should not be postponed or delayed solely because they have been chewing gum or sucking boiled sweets immediately prior to the induction of anaesthesia. 5.9 Infants and children are defined as per the Practice guidelines for preoperative fasting of the American Society of Anaesthesiologists Committee Patients should be encouraged to drink clear fluids up to 2 hours prior to surgery and at least within 4 hours of surgery. In the case of hand surgery where the planned anaesthetic technique is regional anaesthesia alone, patients should be allowed to drink clear fluids until they leave the ward for theatre 5.11 The anaesthetist has final say for the fasting policy in each individual patient in their care and may request alternative fasting times for particular patients or procedures. These should be clearly documented in the medical notes In the case of non-elective procedures where the patient is not fully fasted the risk of aspiration must be balanced against the urgency and the risks of the procedure. 6 Breach Reporting 6.1 A risk event form should be completed and submitted to the Risk Management Department for non-compliance with this guideline in the case of elective procedures. 6.2 In the case of emergency procedures the reasons for not waiting for full fasting should be clearly documented in the medical notes. 7 Audit 7.1 The use of these guidelines will be reviewed by yearly audits by the anaesthetic department. 7.2 The standard for the for fasting times for non-emergency procedures are 100% of patients to have been offered a drink of clear fluid between 2-4 hours before anaesthesia. In the case of hand surgery where the planned anaesthetic technique is regional anaesthesia alone, patients should be allowed to drink clear fluids until they leave the ward for theatre 4

5 8 References 8.1 Smith I et al. Perioperative Fasting in Adults and Children: Guidelines from the European Society of Anaesthesiology. Euro J Anaesthesiology 2011;28(8): American Society of Anaesthesiologists. 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: an updated report by the American Society of Anaesthesiologists Committee on Standards and Practice Parameters. Anaesthesiology 2017; 126: JR Colvin, CJ Peden. Raising the Standards: a compendium of audit recipes for continuous quality improvement in anaesthesia. Royal College of Anaesthetists, 3 rd Edition (2012) 5