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Feeding - Pre-operative guideline for PICU patients going to the OR

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These guidelines apply to ALL enterally fed patients in PICU

Rationale

Providing adequate nutrition is a vital part of intensive care. Many patients in PICU require recurrent trips to the OR often without a set time. This can result in unnecessary prolonged interruptions to their enteral nutrition.

This guideline aims to minimise interruptions to feeding in these patients. It has been discussed with and approved by the SS anaesthesia department. DO NOT deviate from these guidelines.

Intubated Patients

If these patients are absorbing their feeds AND they are NOT having a procedure that involves the airway OR changing the endotracheal tube then they can continue to be fed up until the time that they go to the OR. It does not matter if they are NG or NJ fed.

There may be some instances where these patients should be NPO pre-op. This will be communicated to PICU by the anaesthetic department. The default position is as above.

Non-intubated Patients

Patients who are NJ fed can have this continued up until the time they go to the OR.

ALL other non-intubated patients are NPO as per the SSH anaesthesia department guidelines. See below.

All Patients

Administer all usual medications as charted (IV and oral).

Starship Anaesthesia NPO Guidelines

  • 4 hours breast milk and infant formula.
  • 6 hours cows milk and food.
  • Clear fluids allowed up to 1 hour pre-op. If the child does not have IV fluids running and is a less unwell patient (eg long term patients), oral clear fluids (eg pedialyte) are to be encouraged up to 1 hour prior.

Many children in PICU will be on an acute theatre list, in which case use the table below initially. Often in such cases it is worth contacting the anaesthetic co-ordinator or assigned anaesthetist to ascertain the earliest a patient might be taken to theatre on that day, and adjust fasting times accordingly.

Morning (fasted from 08:30)
Clear fluid 07:30
Breast milk/formula 04:30
All others 02:30
Afternoon (fasted from 13:30)
Clear fluid 12:30
Breast milk/formula 09:30
All others 07:30

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Document Control

  • Date last published: 17 September 2018
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Editor: John Beca
  • Review frequency: 2 years