NPO guidelines, tube feeds, and intubated patients...

[Shimmy8]

What’s the policy and guidelines at your institution or practice?

Gastric feeds vs post-pyloric matter? NPO for all? Keep running if post-pyloric? Doesn’t seem to be a lot good data out there. Thanks for any input.

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[fittipaldi1of1]

At my academic institution, Tube feeds are to continue if airway is not manipulated during case

 

[IMGASMD]

At my academic institution, Tube feeds are to continue if airway is not manipulated during case

Wow. What if it becomes an emergency, rapid sequence and potential aspiration?

The more I do this, the more I think we need to dumb it to the lowest denominator. I really wouldn’t mind, just nothing eat or drink or tube feeds after midnight.

Too many options, for the medical team, nurse and the patients is just too much, IMO.

 

[fittipaldi1of1]

How often does a trached patient lose their airway?
Stopping tube feeds after midnight for patients that need the nutrition is not benign.. some of these burn patients are having debridements or procedures every other day and they truly need their nutrition.

This policy is for patients that are intubated with a cuffed tube or teach and will stay intubated during the case.

 

[IMGASMD]

How often does a trached patient lose their airway?
Stopping tube feeds after midnight for patients that need the nutrition is not benign.. some of these burn patients are having debridements or procedures every other day and they truly need their nutrition.

This policy is for patients that are intubated with a cuffed tube or teach and will stay intubated during the case.

1. Hopefully never.
2. When you’re dealing with specifics, then it should be up to individual physicians to make that determination. As an institution “policy”. I’d still set it for not very smart people.

 

[ButterButter]

If post pyloric, we keep going and pause just before we pick up the pt for the OR. Depending on the duration of the case, medical complexity, etc, we may restart after airway is secure.

 

[nimbus]

Assuming no airway manipulation during the procedure, I see no reason to interrupt tube feeds. Many of these patients are already sedated and not protecting their airway in the ICU. Is propofol in the ICU any different than propofol or propofol+sevo in the OR in terms of aspiration risk?

 

[coffeebythelake]

If patient already tubed, secured, happy, no big concern on my part about stopping feeds.

 

[Twiggidy]

Source: UT Dept of Surgery

 

[Justice4all]

Post pyloric: continue but need to be verified DoS with X-ray

Otherwise 8 hrs

 

[fakin' the funk]

What’s the policy and guidelines at your institution or practice?

Gastric feeds vs post-pyloric matter? NPO for all? Keep running if post-pyloric? Doesn’t seem to be a lot good data out there. Thanks for any input.

This is one of those topics where we, as a specialty, tend to look myopic. I think the trend recently toward more feeding, closer to IR time, is good. There are no good data because true (macro) aspiration is very rare.

There are a subset of ICU patients on TF's for whom holding the feeds for 8-16 hours awaiting a procedure constitutes a major metabolic insult.

Agree with others that the policy "if the airway is secure and not being manipulated, continue feeds"