When to Make Patients NPO
Maggie Doyle
This section covers non-medical reasons for patients to be made NPO in the hospital, including for surgeries, procedures, and imaging studies. See sections on individual medical conditions (e.g., SBO) for NPO considerations.
As a rule of thumb, anything that requires general anesthesia requires the patient to be NPO for 8 hours. By convention, patients are made NPO at midnight.
Circumstance |
Order |
Special Considerations |
|---|---|---|
| Surgeries, exams under anesthesia (EUA), requiring general anesthesia OR Endoscopic evaluations (EGD, ERCP) |
NPO at Midnight | Includes bronchoscopies and other procedures with the interventional pulmonology team |
| Interventional Radiology procedures | NPO at Midnight* | Some procedures (superficial biopsies, certain line placements) are done under local anesthesia. Can err on the side of caution and make NPO unless specifically noted or communicated by IR. |
| Cardiac catheterization | NPO at midnight* | Certain guidelines say 6 hours for solids, 2 hours for clear liquids. Many interventionalists are okay with this (and there’s good data to back it up – see below). However, the rule of thumb is to place NPO at MN order. |
| Cardiac stress Imaging (Stress CMR, nuclear stress tests) | NPO 6 hours before + No caffeine for 24 hours before test | If a patient is scheduled for an afternoon stress imaging study, can let them have breakfast and make NPO 6 hours before. If not yet scheduled, safest to make NPO at midnight. Order “No caffeine for 24 hours” as a nursing communication, make sure to emphasize with patient and the nurse |
| Cardiac PET | NPO 4-6 hours before, no water 1 hour before scan, strict PET diet 24 hours before scan (low carb, low sugar, high protein) | |
| Colonoscopy | Clear Liquid Diet the day prior NPO except bowel prep from midnight day of to 2 hours before |
See “Inpatient Colonoscopy Preparation” Order Panel in Epic |
*In general, but subject to change depending on type of procedures
**By convention, not necessarily data-driven. Multiple trials including CALORI, SCOFF, and TONIC demonstrate that normal diet is non-inferior (and in some cases superior) to NPO.
Things that typically do NOT require a patient to be NPO: Medicine or CT-guided procedures such as paracentesis, thoracentesis, abscess/joint aspirations, lumbar punctures.