Are you NPO (nil per os) for paracentesis?

From the Guidelines

You do not need to be NPO for paracentesis, as the risk of bleeding is low and not significantly affected by fasting status, according to the most recent and highest quality study 1. The study by Grabau et al, as referenced in 1, found no bleeding events in patients with INR >1.5 and platelet count <50,000/mL, suggesting that coagulopathy does not significantly increase the risk of bleeding during paracentesis. Additionally, a study examining 3116 paracenteses found only 6 bleeding events, with no significant difference in mean platelet count or INR between patients who experienced bleeding and those who did not 1. The American Gastroenterological Association technical review on coagulation in cirrhosis also supports this finding, stating that preprocedure bleeding prophylaxis is not necessary for paracentesis in patients with cirrhosis, unless there is clinically evident hyperfibrinolysis or disseminated intravascular coagulation 1. Key points to consider include:

• The risk of bleeding during paracentesis is low, approximately 1 in 1000 procedures 1
• Coagulopathy, as measured by INR and platelet count, does not significantly increase the risk of bleeding during paracentesis 1
• Preprocedure bleeding prophylaxis is not necessary for paracentesis in patients with cirrhosis, unless there is clinically evident hyperfibrinolysis or disseminated intravascular coagulation 1 It is essential to follow your healthcare provider's guidance, as individual circumstances may vary, but in general, NPO status is not required for paracentesis.

From the Research

Paracentesis and NPO

• There is no direct evidence in the provided studies that specifically addresses the use of NPO for paracentesis 2, 3, 4, 5, 6.
• However, the study by 2 discusses the reduction of NPO usage for diagnostic and therapeutic procedures, suggesting that NPO may not be necessary for all procedures.
• The study by 3 provides information on the care of patients undergoing paracentesis, but does not mention NPO specifically.
• Studies 4, 5, and 6 discuss NPO and bleeding reduction in various surgical procedures, but do not directly address paracentesis.
• It can be inferred that the decision to use NPO for paracentesis may depend on individual patient risk factors and the specific procedure being performed, but more research is needed to provide a definitive answer 2, 4.

Relevant Findings

• A study on reducing NPO usage found that NPO requirements were removed from 70% of existing diagnostic imaging and therapeutic orders, with no increase in aspiration events or procedural delays 2.
• Another study suggested that current evidence does not support the routine use of NPO before cardiac catheterization, and that a more targeted approach may be beneficial 4.
• These findings may be relevant to the decision to use NPO for paracentesis, but more research is needed to confirm this.

Procedure-Specific Considerations

• Paracentesis is a procedure used to remove ascitic fluid from the peritoneal cavity, and the decision to use NPO may depend on the individual patient's risk factors and the specific procedure being performed 3.
• The use of NPO may be considered on a case-by-case basis, taking into account the patient's medical history, the type of procedure being performed, and the potential risks and benefits of NPO 2, 4.