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Is there anything official out there whether society guideline or literature? My asc wants several hours Npo for my local pain cases... I think it's ridiculous. Thanks for your help
 

lobelsteve

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Why bother taking local case to ASC? No reason to NPO unless they vagal, aspirate, and need urgent reaction by staff.
 
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Taus

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Why bother taking local case to ASC? No reason to NPO unless they vagal, aspirate, and need urgent reaction by staff.
I'm all asc (actually HOPD)... it's generally been good and efficient, just looking for some literature or guideline support of no need for Npo on local cases
 

Yo GabbaPentin

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I'm all asc (actually HOPD)... it's generally been good and efficient, just looking for some literature or guideline support of no need for Npo on local cases
Are your patients NPO for office visits too? The office visits on a full stomach are roughly the same risk level as injections with local on a full stomach. Just tell the asc that there are no studies for this common sense issue.
 
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Taus

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Are your patients NPO for office visits too? The office visits on a full stomach are roughly the same risk level as injections with local on a full stomach. Just tell the asc that there are no studies for this common sense issue.
Agreed it's ridiculous... and if there are actually no studies or guidelines to support the practice that would be very helpful. I looked through asra, asa websites and found nothing relevant.
 

DOctorJay

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We say npo for one hour prior for some reason. Some pts take it too far and don't eat anything all day. Theyre the ones who vagal
 

Yo GabbaPentin

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Agreed it's ridiculous... and if there are actually no studies or guidelines to support the practice that would be very helpful. I looked through asra, asa websites and found nothing relevant.
There is absolutely no reason for NPO if no sedation. Policy developed by mindless clipboard holding RNs who don't understand the purpose of NPO except that it's a preoperative requirement for surgery.

The likelihood of finding a study on this is as likely as finding a study on why it is a good idea to wear shoes to office visits. Some things just don't need studies.
 
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Ducttape

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for ASC and HOPD sedation cases, i follow the guidelines. this keeps you in line with those posted all throughout the web, cochrane database, guideline.gov. ( http://www.guideline.gov/content.aspx?id=34402 ).


for local cases, not following the guidelines is reasonable, but i would not recommend doing that for ASC cases, but for the reasons not related to guidelines.

first, gastric fullness from a Tremendous 12 or even a Fabulous 5 may prevent a patient from lying flat on their stomach for the procedure. additionally, an odiferous eructation can adversely affect the staff's ability to complete the procedure in question. and yes, i have had at least 3 local cases that i cancelled because of the above, in the past 3 years.

second, you are in an area where everyone else is having actual surgery. I treat the ASC cases like surgery, not like an office based injection (and patients are paying for "surgery", not a simple shot by the doc in some dingy office). and i dont like having to field questions from other patients why their next door neighbor can eat whatever they like while they have to be NPO.

i let them drink as much as they like, clear liquids, after midnight, but no solid food for at least 6 hours before procedure, so that there is no concern.
 

SSdoc33

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for ASC and HOPD sedation cases, i follow the guidelines. this keeps you in line with those posted all throughout the web, cochrane database, guideline.gov. ( http://www.guideline.gov/content.aspx?id=34402 ).


for local cases, not following the guidelines is reasonable, but i would not recommend doing that for ASC cases, but for the reasons not related to guidelines.

first, gastric fullness from a Tremendous 12 or even a Fabulous 5 may prevent a patient from lying flat on their stomach for the procedure. additionally, an odiferous eructation can adversely affect the staff's ability to complete the procedure in question. and yes, i have had at least 3 local cases that i cancelled because of the above, in the past 3 years.

second, you are in an area where everyone else is having actual surgery. I treat the ASC cases like surgery, not like an office based injection (and patients are paying for "surgery", not a simple shot by the doc in some dingy office). and i dont like having to field questions from other patients why their next door neighbor can eat whatever they like while they have to be NPO.

i let them drink as much as they like, clear liquids, after midnight, but no solid food for at least 6 hours before procedure, so that there is no concern.
WTF?

here's what you do: tell the clipboard nurse whatever she wants to hear, but tell the patients they can eat. there is more chance of a complication if the are NPO than if they are not.
 

emd123

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Is there anything official out there whether society guideline or literature? My asc wants several hours Npo for my local pain cases... I think it's ridiculous. Thanks for your help
It is ridiculous
 

lobelsteve

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for ASC and HOPD sedation cases, i follow the guidelines. this keeps you in line with those posted all throughout the web, cochrane database, guideline.gov. ( http://www.guideline.gov/content.aspx?id=34402 ).


for local cases, not following the guidelines is reasonable, but i would not recommend doing that for ASC cases, but for the reasons not related to guidelines.

first, gastric fullness from a Tremendous 12 or even a Fabulous 5 may prevent a patient from lying flat on their stomach for the procedure. additionally, an odiferous eructation can adversely affect the staff's ability to complete the procedure in question. and yes, i have had at least 3 local cases that i cancelled because of the above, in the past 3 years.

second, you are in an area where everyone else is having actual surgery. I treat the ASC cases like surgery, not like an office based injection (and patients are paying for "surgery", not a simple shot by the doc in some dingy office). and i dont like having to field questions from other patients why their next door neighbor can eat whatever they like while they have to be NPO.

i let them drink as much as they like, clear liquids, after midnight, but no solid food for at least 6 hours before procedure, so that there is no concern.
Bloviating nonsense. If i inject a knee in the OR or on a mountain, same rules apply.
 

geauxg8rs

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I just got a Tb skin test and I wasn't npo. I have never been npo for a flu shot either
 

hyperalgesia

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One hospital I know is completely run by nurses and they are Nazis about this. They are so excited when you tell them something and they get to say, "No exceptions, those are the rules!" But the important thing is they always get honors from the Joint Commission. Grrrr...
 

clubdeac

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for ASC and HOPD sedation cases, i follow the guidelines. this keeps you in line with those posted all throughout the web, cochrane database, guideline.gov. ( http://www.guideline.gov/content.aspx?id=34402 ).


for local cases, not following the guidelines is reasonable, but i would not recommend doing that for ASC cases, but for the reasons not related to guidelines.

first, gastric fullness from a Tremendous 12 or even a Fabulous 5 may prevent a patient from lying flat on their stomach for the procedure. additionally, an odiferous eructation can adversely affect the staff's ability to complete the procedure in question. and yes, i have had at least 3 local cases that i cancelled because of the above, in the past 3 years.

second, you are in an area where everyone else is having actual surgery. I treat the ASC cases like surgery, not like an office based injection (and patients are paying for "surgery", not a simple shot by the doc in some dingy office). and i dont like having to field questions from other patients why their next door neighbor can eat whatever they like while they have to be NPO.

i let them drink as much as they like, clear liquids, after midnight, but no solid food for at least 6 hours before procedure, so that there is no concern.
Duct this is ludicrous...not to be confused with Ludacris. You are basically saying make them npo b/c everyone else is and b/c they are paying top dollar for this lumbar facet injection. Uh no... by felicia
 

Ducttape

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I don't know if any of you have recently switched from office based to ASC based, but it costs patients a lot more ( excepting the caid patients). And it is a lot more inconvenient. Instead of "come in Friday we will squeeze you in, at the cost to you of an office visit," patients usually give a separate and almost always much higher copay for an ASC procedure.

My patients don't treat it like the traditional/previous office injection, and are more critical of almost all aspects of their new experience. They also have been taking the injections much more seriously.

Belittling the injection and the amount of extra money they spend is not conducive to a good relationship, so while I am not reverential to the ASC or the experience, I respect the opinions of my patients and their feelings about the process.

That includes standardizing admission guidelines between my local patients, sedation patients, and those of the other physicians who are concurrently there for procedures or surgeries, who almost all use sedation (ortho, pain, a few eyes)...
 

Jcm800

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for ASC and HOPD sedation cases, i follow the guidelines. this keeps you in line with those posted all throughout the web, cochrane database, guideline.gov. ( http://www.guideline.gov/content.aspx?id=34402 ).


for local cases, not following the guidelines is reasonable, but i would not recommend doing that for ASC cases, but for the reasons not related to guidelines.

first, gastric fullness from a Tremendous 12 or even a Fabulous 5 may prevent a patient from lying flat on their stomach for the procedure. additionally, an odiferous eructation can adversely affect the staff's ability to complete the procedure in question. and yes, i have had at least 3 local cases that i cancelled because of the above, in the past 3 years.

second, you are in an area where everyone else is having actual surgery. I treat the ASC cases like surgery, not like an office based injection (and patients are paying for "surgery", not a simple shot by the doc in some dingy office). and i dont like having to field questions from other patients why their next door neighbor can eat whatever they like while they have to be NPO.

i let them drink as much as they like, clear liquids, after midnight, but no solid food for at least 6 hours before procedure, so that there is no concern.
this is some silly stuff im reading...