Asking patients to fast before cardiac catheterization procedures does not appear to add any clinical value, according to new research published in the American Journal of Critical Care.[1] In fact, following a heart-healthy diet before entering the cath lab is linked to multiple benefits for patients without increasing the risk of poor outcomes.
“Patients scheduled for coronary artery catheterization typically have orders to take nothing by mouth after midnight before the procedure, requiring them to fast for six hours or longer depending on the time of the procedure,” wrote first author Carri Woods, MBA, MSN, RN, a nursing manager with the Parkview Heart Institute in Fort Wayne, Indiana, and colleagues. “Requiring patients to fast has negative effects such as general discomfort, irritability, dehydration, increased thirst and hunger, and hypoglycemia. Currently, no evidence supports the fasting requirements for patients at low to medium risk who are scheduled for cardiac catheterization.”
Woods et al. tracked data from nearly 200 patients who underwent an elective cardiac catheterization procedure at a single U.S. facility. All patients were 18 years old or older. Patients presenting with preexisting conditions related to gastric emptying or a large hiatal hernia were excluded. No emergency catheterizations were included in the team’s analysis.
Patients were randomized to follow one of two approaches the night before the procedure. While 97 patients started fasting at midnight, which meant only small sips of water were allowed, another 100 patients were instructed to follow a heart-healthy diet low in fat, cholesterol and sodium.
As one might expect, feelings of thirst and hunger were lower before and after cardiac catheterization among patients who followed a heart-healthy diet. Satisfaction with the preprocedural diet was also significantly higher among these patients.
Meanwhile, when scanning patient outcomes for any potential negative side effects of allowing patients to eat before the procedure, the authors found that there was nothing to report.
“No patients experienced post-procedural pneumonia, aspiration, intubation, or hypoglycemia,” the authors wrote. “Fatigue, glucose level, gastrointestinal issues, and use of loading dose of anti-platelet medication did not differ between the groups.”
Woods and colleagues also noted that fasting patients may face an increased risk of certain clinical complications, including hypoglycemia, dehydration and even malnutrition. This represents yet another benefit of embracing updated policies and allowing pre-cardiac catheterization fasting to be a thing of the past.
“Patients can safely continue oral intake until the time of the procedure, improving their satisfaction and comfort without adverse events,” they wrote. “Patient care can be compromised by inadequate preoperative nutrition, and patients’ experiences are also affected when they fast for prolonged periods.”
The researchers concluded that additional studies with more patients are still required to ensure these findings can be generalized to all patients. Industry societies, they added, should review their policies and consider making changes.
Click here to read the full study in the American Journal of Critical Care, a publication of the American Association of Critical Care Nurses.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.