From the Guidelines
Fasting is not required prior to Cardiac Catheterization (Cardiac Cath)/Cardiovascular Implantable Electronic Device (CIED)-related procedures, and patients can typically consume clear liquids up to 2 hours before the procedure. The American Society of Anesthesiologists recommends a 2-h minimum fasting period for clear liquids, and the American College of Emergency Physicians notes that fasting may not be an option for time-sensitive procedures, with no evidence that noncompliance with elective fasting guidelines increases the risk of aspiration or other adverse events 1.
Key Considerations
- Patients can consume a light meal up to 6 hours before the procedure, and clear liquids up to 2 hours prior, as recommended by the American Society of Anesthesiologists 1.
- Specific medications should be managed appropriately, including continuing most cardiac medications with a small sip of water, holding oral hypoglycemics on the day of the procedure, adjusting insulin doses to prevent hypoglycemia, and managing anticoagulants according to procedure-specific protocols.
- The traditional NPO approach has been reconsidered, as these procedures rarely require general anesthesia, and prolonged fasting can lead to dehydration, electrolyte imbalances, and hypoglycemia, which may increase procedural complications 1.
- Maintaining hydration actually improves vascular access and reduces contrast-induced nephropathy risk.
Patient-Specific Factors
- Individual patient factors, such as diabetes, kidney disease, or specific procedural requirements, may necessitate customized fasting instructions, so patients should always follow their healthcare provider's specific guidance.
- In urgent or emergent situations, moderate procedural sedation should not be delayed based on fasting time alone, as noted by the American Society of Anesthesiologists 1.
From the Research
Fasting Requirements for Cardiac Catheterization and CIED-related Procedures
- The practice of fasting before elective cardiac procedures, including cardiac catheterization and CIED-related procedures, is commonly implemented, but evidence for these requirements is lacking 2.
- Studies have shown that fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines 2, 3.
- The risk of serious aspiration is small in elective cardiac procedures that utilize procedural sedation, suggesting that strict fasting requirements may not be necessary 2, 4.
Comparison of Fasting and No-Fasting Strategies
- A randomized trial found that no fasting was non-inferior and superior to fasting for the primary composite outcome of aspiration pneumonia, hypotension, hyperglycaemia, and hypoglycaemia in patients undergoing cardiac catheterization and CIED-related procedures 4.
- The no-fasting arm had improved patient satisfaction scores and similar secondary outcome events compared to the fasting arm 4.
- Another study found that most patients were fasted for significantly longer than recommended, and pre-hydration was underutilized in patients at high risk of contrast-induced nephropathy, with no episodes of aspiration reported 3.
Safety and Efficacy of No-Fasting Protocol
- A systematic integrative literature review found that not fasting before cardiac catheterization is considered safe and beneficial for the patient when compared to the risks of fasting 5.
- A non-inferiority randomized control trial protocol found that routine fasting may not reduce peri-procedural adverse events in cardiac catheterization procedures 6.
- The evidence suggests that a more nuanced fasting protocol based on individual patient characteristics and risk factors may be more appropriate than strict fasting requirements 2, 4, 5.