Preoperative fasting is an experience which each individual must endure before entering the operating theatre. Fasting is an essential step. The purpose of fasting is to empty the stomach to reduce the risk of aspiration (Hamlin et al, 2009). Even though I am just a first year student with very little experience, I have already seen some conflicting recommendations regarding this subject. While working in the ward, nurses encouraged preoperative fasting to start at midnight which was different to what we learnt in our lectures, in which a preoperative fast of 4-6hrs was recommended.
Guidelines for Preoperative Fasting.
In 1999, the American Society of Anaesthesiologists ...view middle of the document...
In some studies patients have fasted for a severe 37 hours from solids and 20 hours for fluids. Prolonged fasting can affect patient’s physical and psychological well-being.
Risk Assessment on pre-operative patients
On assessment some people may be considered to more likely regurgitate while under anaesthetic such as pregnant women, obese patients or patients with abdominal disorders etc. Patients who are also very ill or have been involved in an accident such as a car accident and they need surgery, they will be treated as they have a full stomach. An anaesthetist makes the risk assessment who would have been fully informed by the preoperative nurse of what the patients has recently eaten and drank (Hamlin et al, 2009).
The barriers to best practice
Prolonged preoperative fasting can be damaging to patients. Guidelines have changed over time from "nil by mouth from midnight”, to now where you only have to fast for two hours minimum form oral fluids. Nurses are expected to carry out these guidelines accordingly (Scott and Marfell-Jones, 2004). So why are patients fasting for prolonged periods of time? One reason I found is that nurses tend not to keep up with current literature in nursing. This could be due to the absence of time and motivation and also the lack of access to articles (Woodhouse, 2006) A great deal of research has taken place on safe preoperative fasting times, but still the majority of nurses are not mindful of the fact that lengthening the period of the fast does not improve patient safety and that the longer patients go without food and fluids, the greater the risk. British researcher Alun Woodhouse, suggested a possible barrier that would shorten fasting -times is to try and fix the power imbalance between nurses and doctors (Woodhouse, 2006). The nurses that took part in his study were said to have felt anxious and tense when they had to question doctors regarding preoperative fasting.
Managing acute patients
Organising patients for acute surgery can be challenging for nurses who attempt to lessen the period of the time patients are fasting for when possible. Acute patients going for surgery usually fast for a considerable amount of time longer than those on elective lists. Therefore they are at a greater risk of complications. There are many reasons for prolonged fasting such as lack of communication between theatre staff and ward staff, changes in theatre lists and capacity for acute surgery. In Letterkenny General Hospital there are Clinical Nursing Mangers (CNM) in each ward. In Surgical wards they are responsible for overseeing all the patients that are going to theatre, where they will go after theatre, and planning when and where acute surgery gets performed.
Adverse effects of fasting
There are many physical effects of extreme fasting for clients can include hypoglycaemia, electrolyte imbalance, poor wound healing, increased risk of developing pressure sores and a depressed immune system (Bothamley and...