Preprocedural fasting policies for patients receiving tube feeding: A national survey

Abstract

BackgroundCritically ill patients frequently accrue substantial nutritional deficits due to multiple episodes of prolonged fasting prior to procedures. Existing literature suggests that for most patients receiving tube feeding the aspiration risk is low. Yet, national and international guidelines do not address fasting times for tube feeding, promoting uncertainty regarding optimal pre‐procedural fasting practice. We aimed to characterize current institutional fasting practices in the United States for patients with and without a secure airway, with variable types of enteral access, for representative surgical procedures.MethodsThe survey was distributed to a purposive sample of academic institutions in the United States. Reponses were reported as restrictive (six to eight hours pre‐procedurally) or permissive (less than six hours or continued intra‐procedurally) feeding policies. Differences between level 1 trauma centers and others, and between burn centers and others, were evaluated.ResultsThe response rate was 40.3% (56 of 139 institutions). Responses revealed a wide variability with respect to current practices, with more permissive policies reported in patients with secure airways. In patients with a secure airway, Level 1 trauma centers were significantly more likely to have permissive fasting policies for patients undergoing an extremity incision & drainage for each type of feeding tube surveyed.ConclusionsCurrent hospital policies for pre‐procedural fasting in patients receiving tube feeds are conflicting and are frequently more permissive than guidelines for healthy patients receiving oral nutrition. Prospective research is needed to establish the safety and clinical effects of various fasting practices in tube‐fed patients.This article is protected by copyright. All rights reserved.