Should a patient with a history of seizure disorder or encephalopathy be kept NPO (nothing by mouth) for PICC (peripherally inserted central catheter) line placement?

NPO Status for PICC Line Placement

Patients do NOT need to be NPO for routine PICC line placement, as this is a bedside procedure performed under local anesthesia that does not require sedation.

Rationale for No NPO Requirement

PICC line insertion is fundamentally different from procedures requiring sedation or general anesthesia:

• PICC placement is performed at the bedside using only local anesthesia, making NPO status unnecessary for the procedure itself 1.
• The procedure does not involve airway manipulation or sedation that would increase aspiration risk 1.
• No guidelines or evidence support routine NPO status specifically for PICC line placement 1.

Important Context for Patients with Seizure Disorder or Encephalopathy

While PICC placement itself doesn't require NPO status, patients with seizure disorders or encephalopathy should remain NPO until swallowing ability is formally assessed, but this is independent of the PICC procedure:

• All stroke and encephalopathy patients must remain NPO until a validated swallowing screen is completed to prevent aspiration risk from their underlying neurological condition 1.
• This NPO status relates to the patient's baseline aspiration risk from dysphagia, not the PICC procedure 1.
• Swallowing screening should ideally occur within 24 hours of hospital arrival and must be completed before any oral intake 1.

Clinical Algorithm

For routine PICC placement:

• No NPO requirement
• Proceed with placement when clinically indicated
• Local anesthesia only 1

For patients with neurological conditions (seizures, encephalopathy, stroke):

• Keep NPO until swallowing screen completed 1
• This is for aspiration prevention from their underlying condition, not the PICC procedure
• PICC can still be placed while patient is NPO 1
• Use alternative medication routes (IV, rectal) until swallowing assessed 1

Common Pitfall to Avoid

Do not delay medically necessary PICC placement waiting for a patient to be NPO, as this requirement does not exist for the procedure itself 1. The only scenario requiring NPO consideration is if the patient has an underlying condition (like dysphagia from stroke) that independently necessitates NPO status for aspiration prevention 1.