Pre-procedure Instructions
Prepare patients safely for cardiac procedures — NPO, medication holds, and confirming understanding.
Learning Objectives
- 1.Deliver clear, accurate pre-procedure instructions.
- 2.Know which medications commonly need holding and to confirm with the provider/protocol.
- 3.Confirm understanding and flag risks before the procedure.
Purpose
A safe procedure starts the day before. Clear prep instructions — NPO, which meds to hold or take, and a ride home — prevent cancellations and complications.
What to confirm / instruct
- •NPO instructions per protocol (time to stop eating/drinking).
- •Which meds to hold vs. take (per provider/protocol) — especially anticoagulants, diabetes meds, diuretics.
- •Arrival time, location, and a driver for sedation procedures.
- •Allergies, including contrast/iodine and prior reactions.
- •Bring a current medication list.
Meds that often need attention
- •Anticoagulants/antiplatelets — hold timing is provider/procedure-specific; confirm, never guess.
- •Diabetes meds (e.g., metformin, insulin) — often adjusted for NPO/contrast.
- •Diuretics — sometimes held the morning of.
Scope note
Medication holds are provider/protocol decisions. The nurse confirms and communicates the plan — don’t independently tell a patient to stop an anticoagulant.
Red flags to flag before the procedure
- •Active illness/fever, uncontrolled symptoms, or new chest pain.
- •Contrast allergy not previously addressed.
- •Confusion about anticoagulation hold.
- •No ride home for a sedation procedure.
Escalate
Unresolved anticoagulation questions, allergies, or new symptoms before a procedure go to the provider/team before the day of.
What to document
- •Instructions given and confirmed, med-hold plan source, allergies, transportation, and teach-back result.
Patient education script
- •"Nothing to eat or drink after ___. Take these medicines with a sip of water; hold these per the provider."
- •"You’ll need a driver. Bring your medication list and arrive at ___."
Spanish phrase
Do not eat or drink anything after midnight before your procedure.
No coma ni beba nada después de la medianoche antes de su procedimiento.
noh KOH-mah nee BEH-bah NAH-dah des-PWES deh lah meh-dyah-NOH-cheh AN-tes deh soo proh-seh-dee-MYEN-toh
Mini case
A patient scheduled for a cath tomorrow asks if they should take their apixaban tonight.
What do you do?
Show answer
Don’t guess — anticoagulation holds are procedure/provider-specific. Confirm the hold plan with the provider/protocol, then relay clear instructions and document. Confirm they understand with teach-back.
Checklist
- NPO and med-hold instructions confirmed against protocol.
- Allergies and contrast history reviewed.
- Driver/transportation arranged for sedation.
- Teach-back confirmed understanding.