Do you need to be NPO (nothing by mouth) for a Transesophageal Echocardiogram (TEE) procedure?

From the Guidelines

You do not necessarily need to be NPO for a Transesophageal Echocardiogram (TEE) procedure, as clear liquids may be safely consumed up to 2 to 4 hours before the test, according to recent guidelines 1. When considering the requirements for a TEE, it's essential to prioritize the patient's safety and the success of the procedure. The traditional approach has been to fast for at least 6 hours before the test to minimize the risk of aspiration. However, more recent recommendations suggest that clear liquids can be continued up to 2 to 4 hours before the procedure, which aligns with enhanced recovery after surgery (ERAS) protocols 1. Key considerations for TEE preparation include:

• The risk of aspiration, which may be increased in patients with delayed gastric emptying, such as those with diabetes mellitus
• The potential for transesophageal echocardiography to increase aspiration risk
• The importance of clear images of the heart, which may be compromised by a full stomach It's crucial to follow specific instructions provided by your healthcare provider regarding medication management, particularly for blood thinners, diabetes medications, or other daily medications that might need adjustment due to the fasting period. In the context of real-life clinical medicine, the decision to allow clear liquids up to 2 to 4 hours before a TEE should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history, as supported by the guidelines 1.

From the Research

NPO Requirements for TEE Procedure

• The need to be NPO (nothing by mouth) for a Transesophageal Echocardiogram (TEE) procedure is a topic of discussion, with evidence suggesting that strict fasting requirements may not be necessary for all patients 2.
• A study published in 2023 argues that fasting periods often exceed the intended length of time, increasing the risk of irritability, dehydration, acute kidney injury, hypoglycemia, and length of hospitalization, without guaranteeing an empty stomach or reducing the risk of aspiration 2.
• The use of procedural sedation during TEE procedures reduces the risk of serious aspiration, making strict fasting requirements less critical 2.
• Another study from 2016 highlights the importance of sedation during TEE procedures, comparing the effects of different sedation agents, but does not specifically address NPO requirements 3.

Sedation and Monitoring in TEE

• Sedation is an essential component of the TEE procedure for patient comfort, with cardiologist-supervised and anesthesiologist-supervised sedation being used in different cases 4.
• The choice of sedation agent and approach may depend on patient factors, such as obstructive sleep apnea, body mass index, and cardiac abnormalities 4.
• Monitoring during TEE procedures is crucial, with attention to hemodynamic changes, respiratory events, and other potential complications 4, 5.

Guidelines and Recommendations

• The American Society of Echocardiography has created guidelines for performing TEE examinations, including those for use in the operating room 6.
• A narrative review of the 2020 guidelines highlights the importance of TEE in assisting with surgical decision-making and provides a starting protocol for conducting TEE examinations in different cardiac surgeries 6.
• However, there is no clear consensus on NPO requirements for TEE procedures, and more studies are needed to support the use of TEE outside of cardiac surgery at its full potential 5.