Catheterization & intervention

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NPO and fluids

Most patients

To prevent vomiting and aspiration, oral intake is generally held for at least six hours preceding elective procedures. An exception is usually made for oral medications with enough clear liquid to permit swallowing the pills.
A reasonable “all-round” infusion to keep an intravenous site available is 5% Dextrose in half-normal saline with the addition of 20 mEq of KCl per liter running at 50 cc/hour.

Special circumstances

Patients with renal impairment are generally given sufficient fluid prior to a procedure involving contrast media to avoid volume depletion.
Patients with decompensated heart failure are, by definition, volume overloaded and should not be given additional large volumes of fluid to “protect” renal function during diagnostic study or intervention. In many of these patients diuresis immediately before or during the procedure is more appropriate.
Diagnostic studies and interventions should sometimes be performed separately among patients with significant renal impairment or uncompensated heart failure.

Following a procedure

Radiographic contrast is a potent osmotic diuretic
Short procedures with limited amounts of contrast and little sedation can be managed with encouragement of post-procedure oral fluid intake.
Diabetic patients are usually given half-normal saline with 20 meq of KCL per liter
Dextrose in half-normal saline with the addition of 20 mEq of KCl per liter urunning at 50 to 100 cc/hour is a reasonable replacement solution for the first 5 to 10 hours following a prolonged procedure.