Paediatric fasting requirement pre cardiac catheterisation / cardiac surgery

Objectives

To allow standardised fasting instructions for any cardiac patient requiring a general anaesthetic.

Scope

This guideline applies to all pre-operative cardiac patients within the hospital.

Audience

This guideline is intended for all healthcare professionals involved in the care of paediatric patients pre cardiac catheterisation/cardiac surgery.

Background

Children with congenital heart disease may be cyanotic, this causes an increase in erythropoietin thereby raising haematocrit, haemogloblin and blood viscosity.

Hyperviscosity is associated with stroke especially in young children in the presence of dehydration and so all children with cyanosis should have fasting kept to a minimum.

Paediatric fasting requirement pre cardiac catheterisation/surgery flowchart

Enteral fluids - water or diluting juice

Cyanotic patients:

Encourage enteral intake up to 1 hour pre procedure, particularly in the following patients:

BT Shunt/PDA Stent
Post stage I HLHS
Sp02 < 75%

If IV fluids are necessary prescribe 100% fluid requirement, to cover fasting period. As per GG&C Guideline.

Audit and Review

This guideline will be reviewed every 2 years with reference to clinical governance including review of associated guidelines, clinical incidents and audit.

References

Preoperative fasting of Elective Patients, Royal Hospital for Children

Intravenous Fluid Guidance in Previously Well Children Aged 7 days to 16 Years

Starship NZ. Guideline: Cardiac Surgery – Admission Process

White, MC (2011). Approach to managing children with heart disease for non-cardiac surgery. Pediatric Anesthesia (21), pp.522-529

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1460-9592.2010.03416.x

Evidence method

This policy was drawn up from best available evidence including consultation with local cardiologists, cardiac surgeons, anaesthetists, nursing staff, local practice and existing guidelines.