Enhanced Recovery Pathway for Endoscopy

NCT ID: NCT04983498

Last Updated: 2021-12-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2021-09-01

Study Completion Date

2022-01-01

Brief Summary

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The purpose of this study is to compare an Enhanced Recovery Pathway to the current pre-operative/recovery practices of the endoscopy department on patient post-procedure outcomes.

Detailed Description

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Every 4th to 5th patient that checks in to the endoscopy department for their procedure will be screened for eligibility requirements. If eligible for the study, the patient will be informed about the study and potential risks. All patients giving written informed consent will be enrolled into the enhanced recovery protocol (ERP) \[nursing managed ERP: goal-directed fluid management (Lactated Ringer's Solution at 5mL/kg/hr), PONV prophylaxis for an apfel score of 2 or greater (ondansetron 4 mg IV), early mobilization up to chair (within 5-30 minutes of admission to the recovery room), and early PO intake within 15-30 minutes of admission to the recovery room post-procedure\] for their procedure.

Conditions

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Enhanced Recovery Pathway Endoscopy

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Prospective Experimental Group

For the experimental group, we will recruit 200 participants who will receive the Enhanced Recovery Pathway, which will be ordered as a standing order set by the attending provider and managed by their peri-procedural nurses. The modified ERP for this study includes the following interventions: nursing managed order sets with ERP instructions to receive goal-directed fluid management within anesthesia approved parameters utilizing the NMH Colorectal ERAS protocol for IV fluid administration, PONV prophylaxis for participants with an apfel score of 2 or greater (ondansetron 4 mg IV), an additional dose of ondansetron 4mg IV will be available in recovery if the patient has nausea/vomiting despite prophylaxis, early mobilization up to chair (within 5-30 minutes of admission to the recovery room) based on nursing parameters, and early PO intake within 15-30 minutes of admission to the recovery room post-procedure based on nursing parameters.

Group Type EXPERIMENTAL

Ondansetron 4 MG

Intervention Type DRUG

PONV prophylaxis for participants with an apfel score of 2 or greater (ondansetron 4 mg IV), an additional dose of ondansetron 4mg IV will be available in recovery if the patient has nausea/vomiting despite prophylaxis.

Lactated Ringers, Intravenous

Intervention Type DRUG

Goal directed IV fluids to be administered starting preop per the NMH Colorectal ERAS protocol (LR @ 5mL/kg/hr).

Early Mobilization

Intervention Type OTHER

Patient transferred up to the chair (within 5-30 minutes of admission to the recovery room) based on nursing parameters and patient safety.

Early PO Intake

Intervention Type OTHER

Patient will be offered PO intake within 15-30 minutes of admission to the recovery room post-procedure based on nursing parameters and patient safety.

Retrospective Control Group

The retrospective group will consist of 200 randomly selected medical records of patients who had colonoscopy procedures for a 6 month period prior to study implementation (between 10/1/2019 to 4/1/2020). The retrospective control group will have received the current standard of care including: IV fluids for management of intra-procedural hypotension as indicated/ordered by the physician, PO intake at 30-45 minutes, up to a chair at 60 minutes, and all procedure related complications will have been treated (e.g. PONV) per physician order as is the current standard of practice in the GI Lab recovery area.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Ondansetron 4 MG

PONV prophylaxis for participants with an apfel score of 2 or greater (ondansetron 4 mg IV), an additional dose of ondansetron 4mg IV will be available in recovery if the patient has nausea/vomiting despite prophylaxis.

Intervention Type DRUG

Lactated Ringers, Intravenous

Goal directed IV fluids to be administered starting preop per the NMH Colorectal ERAS protocol (LR @ 5mL/kg/hr).

Intervention Type DRUG

Early Mobilization

Patient transferred up to the chair (within 5-30 minutes of admission to the recovery room) based on nursing parameters and patient safety.

Intervention Type OTHER

Early PO Intake

Patient will be offered PO intake within 15-30 minutes of admission to the recovery room post-procedure based on nursing parameters and patient safety.

Intervention Type OTHER

Other Intervention Names

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Post-operative Nausea & Vomiting Prophylaxis Intravenous Hydration

Eligibility Criteria

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Inclusion Criteria

* Outpatient colonoscopy under moderate sedation
* Colonoscopy Indications: Screening

Exclusion Criteria

* More than one sedation procedure scheduled same day
* Allergy to ondansetron
* Past PONV requiring scopolamine patches
* Diagnoses: ESRD, heart failure, cirrhosis, long QT syndrome
* Patients requiring fluid restrictions, such as dialysis patients
* Post-procedure NPO requirements, such as procedure-related NPO status (stent placement, pneumatic dilation, etc.) or second procedure in another location
* High Fall Risk Patients
* Adults unable to consent
* Pregnant patients
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Northwestern University

OTHER

Sponsor Role lead

Responsible Party

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Angela Maeder

PhD, RNC-OB, Clinical Nurse, Labor and Delivery Northwestern Memorial Hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Angela Maeder, PhD

Role: PRINCIPAL_INVESTIGATOR

Northwestern Medicine

Locations

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Northwestern Memorial Hospital

Chicago, Illinois, United States

Site Status

Countries

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United States

References

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Alghanem SM, Massad IM, Rashed EM, Abu-Ali HM, Daradkeh SS. Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting. Surg Endosc. 2010 Feb;24(2):353-8. doi: 10.1007/s00464-009-0567-3. Epub 2009 Jun 11.

Reference Type BACKGROUND
PMID: 19517165 (View on PubMed)

Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc. 2013 Nov 16;5(11):527-33. doi: 10.4253/wjge.v5.i11.527.

Reference Type BACKGROUND
PMID: 24255744 (View on PubMed)

Brown JK, Singh K, Dumitru R, Chan E, Kim MP. The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery. Methodist Debakey Cardiovasc J. 2018 Apr-Jun;14(2):77-88. doi: 10.14797/mdcj-14-2-77.

Reference Type BACKGROUND
PMID: 29977464 (View on PubMed)

Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N; IMPACT Investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004 Jun 10;350(24):2441-51. doi: 10.1056/NEJMoa032196.

Reference Type BACKGROUND
PMID: 15190136 (View on PubMed)

Ellett ML. Review of propofol and auxiliary medications used for sedation. Gastroenterol Nurs. 2010 Jul-Aug;33(4):284-95; quiz 296-7. doi: 10.1097/SGA.0b013e3181eac371.

Reference Type BACKGROUND
PMID: 20679780 (View on PubMed)

Crenshaw JT, Winslow EH. Preoperative fasting: old habits die hard. Am J Nurs. 2002 May;102(5):36-44; quiz 45. doi: 10.1097/00000446-200205000-00033.

Reference Type BACKGROUND
PMID: 12006853 (View on PubMed)

Gan TJ. Postoperative nausea and vomiting--can it be eliminated? JAMA. 2002 Mar 13;287(10):1233-6. doi: 10.1001/jama.287.10.1233. No abstract available.

Reference Type BACKGROUND
PMID: 11886298 (View on PubMed)

Joliat GR, Ljungqvist O, Wasylak T, Peters O, Demartines N. Beyond surgery: clinical and economic impact of Enhanced Recovery After Surgery programs. BMC Health Serv Res. 2018 Dec 29;18(1):1008. doi: 10.1186/s12913-018-3824-0.

Reference Type BACKGROUND
PMID: 30594252 (View on PubMed)

Lichtenstein GR, Cohen LB, Uribarri J. Review article: Bowel preparation for colonoscopy--the importance of adequate hydration. Aliment Pharmacol Ther. 2007 Sep 1;26(5):633-41. doi: 10.1111/j.1365-2036.2007.03406.x.

Reference Type BACKGROUND
PMID: 17697197 (View on PubMed)

Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952.

Reference Type BACKGROUND
PMID: 28097305 (View on PubMed)

Saraghi M. Intraoperative Fluids and Fluid Management for Ambulatory Dental Sedation and General Anesthesia. Anesth Prog. 2015 Winter;62(4):168-76; quiz 177. doi: 10.2344/0003-3006-62.4.168.

Reference Type BACKGROUND
PMID: 26650497 (View on PubMed)

Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: A simple yet complex problem. Anesth Essays Res. 2016 Sep-Dec;10(3):388-396. doi: 10.4103/0259-1162.179310.

Reference Type BACKGROUND
PMID: 27746521 (View on PubMed)

Som A, Bhattacharjee S, Maitra S, Arora MK, Baidya DK. Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis. Anesth Analg. 2016 Dec;123(6):1418-1426. doi: 10.1213/ANE.0000000000001617.

Reference Type BACKGROUND
PMID: 27870735 (View on PubMed)

Weinberg L, Faulkner M, Tan CO, Liu DH, Tay S, Nikfarjam M, Peyton P, Story D. Fluid prescription practices of anesthesiologists managing patients undergoing elective colonoscopy: an observational study. BMC Res Notes. 2014 Jun 10;7:356. doi: 10.1186/1756-0500-7-356.

Reference Type BACKGROUND
PMID: 24916073 (View on PubMed)

Other Identifiers

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STU00214245

Identifier Type: -

Identifier Source: org_study_id