Category: For Med Pros

Preparing Your Patients for Surgery with the ClearFast Enhanced Recovery Drink: Your Top 5 Questions Answered

With traditional NPO on its way out and pre-surgery carbohydrate loading taking its place, we’re now on the forefront of a major shift in the way the medical industry looks at surgery prep. This shift means that our team often gets asked a number of great questions about safely preparing patients for surgery with our enhanced recovery drink. We understand that, as medical professionals, your number-one goal is to ensure safe and effective surgical outcomes and overall patient satisfaction—which is why, today, we wanted to take some time to answer the top five questions we hear from physicians and healthcare centers. Read on for answers to our most common medical-pro FAQs.

1. We’ve always done NPO. Why should I be ClearFasting my patients now?

More and more medical research is pointing to the fact that pre-op carbohydrate loading with a clear, complex carb-rich beverage leads to safer procedures and greater patient satisfaction. There are a number of science-backed reasons you should consider replacing NPO with fasting with an enhanced recovery drink instead, including:

• Fluid Fasting Leads to Lower Stomach Acidity: The purpose of NPO is ultimately to reduce a patient’s risk of aspiration. Recent medical studies have found, however, that fluid fasting in place of NPO works to raise the pH in a patient’s stomach, leading to lower gastric acids and, ultimately, a reduced risk of aspiration under anesthesia. (You can read more about lowering stomach acidity and increasing patient safety with fluid fasting here.)

• Evidence-Based vs Non-Evidence Based: It’s important to keep in mind that NPO was never an evidence-based practice. Enhanced Recovery After Surgery Programs (ERAS®), evidence-based programs borrowed from Europe and the UK, are becoming increasingly popular in luminary hospitals across the United States. These programs are comprised of 17 key elements for perioperative patient management, which, when combined, work to ensure a better surgical outcomes, enhanced recovery after surgery and increased patient satisfaction overall. One of the most important of the 17 elements is preoperative carbohydrate loading using a compliant ERAS® drink like ClearFast in place of NPO. (You can read more about choosing the right ERAS® drink for better surgical outcomes here.)

• Higher Patient Satisfaction, Reduced PONV, Shorter Hospital Stays: In a large controlled study, patients in the pre-op area who drank ClearFast were 5.5-6.5 times more likely to describe themselves as “comfortable” than their cohorts who underwent traditional fasting from midnight. In addition to creating a more comfortable pre-surgery experience for patients, fluid fasting with the ClearFast enhanced recovery drink reduces a patient’s risk of PONV, ultimately decreasing the length of hospital stay.

2. Can my diabetic patients have ClearFast?

Any medical pro knows that preparing a diabetic for surgery is far more nuanced than preparing a healthy patient for surgery. Pre-op carb-loading for diabetics is actually one of the safest, most effective ways to manage blood sugar levels before, during and after surgery—which results in a number of benefits, including:

• It reduces a diabetic patient’s risk of pre-op complications: Diabetic patients are often the most adversely affected by prolonged fasting, as a prolonged fast can ultimately send their body into a catabolic state—which, for a diabetic, can lead to serious complications like hyperglycemia and even ketoacidosis. Rather than ignoring a diabetic’s unique dietary needs as traditional NPO does, a fluid fast with the ClearFast enhanced recovery drink works with a diabetic’s dietary needs, ultimately protecting their critical glycogen stores.

• It reduces a diabetic patient’s risk of postoperative insulin resistance (PIR): Numerous studies have found that pre-op carb-loading with a complex carb-rich, clear preop drink like ClearFast can reduce a diabetic’s risk of post-op insulin resistance and post-op infections, as well as reduce the occurrence of PONV—all of which make managing blood-sugar difficult, posing particular danger for those with diabetes. (You can read more about preparing your diabetic patients for surgery with ClearFast here.)

3. What about patients with gastroparesis or GERD?

We typically recommend patients finish their last bottle of ClearFast two hours prior to their surgery time; however we’ve modified these recommendations for those with delayed gastric emptying so as to avoid the risk of aspiration. Instead of a final dose completed two hours before surgery, we recommend you push the final dose to four hours before surgery. Again, as a physician, you always have the best, most informed guidance for your individual patient’s gastric emptying times.

4. Can my pediatric patients use the ClearFast enhanced recovery drink?

Absolutely! Pediatric patients are often the hardest to fast, which is why ClearFast is such a great option to keep them happy, hydrated and nourished before surgery. A pediatric patient’s dosing, of course, will differ from that of an adult’s depending on their weight and age. Take a look at our ClearFast Pediatric Dosing Chart for specific dosage recommendations to determine the best way to prep your pediatric patients for surgery with the ClearFast enhanced recovery drink.

5. You talk a lot about infection rates. How can ClearFast help with that?

NPO induces a catabolic state wherein the normal relationship between insulin and glucose are uncoupled. To compensate for the lack of “fuel” brought on by fasting, the body uses up its critical glycogen stores and then begins to breakdown fat and muscle as alternative energy sources. Insulin levels rise in response to rising glucose levels, but target cells (including muscle) fail to respond to it. In effect, patients become insulin-resistant. When patients are insulin-resistant after surgery and have a fresh surgical incision, the chance for infection greatly increases, as the “sweet environment” invites microbial colonization.  Fluid fasting with the ClearFast enhanced recovery drink, on the other hand, effectively protects or spares critical glycogen stores in the immediate pre-op window and stabilizes blood sugars—reducing a patient’s risk of hyperglycemia and any associated infection. Ultimately, by reducing a patient’s risk of postoperative insulin resistance or PIR, ClearFast helps to reduce the risk of surgical infection.

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Have we answered all of your questions? We hope so! If you’re ready to improve outcomes for your patients and your hospital, you can order your ClearFast Preop Drink here. Or, reach out to the ClearFast team at support@drinkcf.com if you have any questions at all. We’re always here and happy to help!

Liquid Fasting for Orthopedics Patients, Diabetics and More: The Unique Benefits of ClearFast for Different Types of Surgery

Fluid fasting before surgery offers a number of valuable benefits for patients across the board—like reduced post-op nausea and vomiting, and a less stressful surgery experience—but today we wanted to break down the specific benefits of fluid fasting as they apply to different service lines. From liquid fasting for orthopedics patients to liquid fasting for diabetics, preparing for surgery with a complex carb-rich preop drink like ClearFast provides a distinct set of benefits for different types of procedures. Today, we’ll cover:

• How ClearFast reduces an orthopedics patient’s risk of infection

• How ClearFast makes for safer surgeries for diabetics

• How ClearFast helps to hydrate and nourish dehydrated colorectal & colonoscopy patients

Now, let’s dig in…

Liquid Fasting for Orthopedics Patients

The unique problem: Increased risk of Infection

Fasting from midnight, which was never evidence-based, induces a catabolic state where the normal relationship between insulin and glucose are uncoupled. To compensate for the lack of “fuel” brought on by fasting, the body uses up its critical glycogen stores and then begins to breakdown fat and muscle as alternative energy sources. Insulin levels rise in response to rising glucose levels, but target cells (including muscle) fail to respond to it. In effect, patients become insulin resistant.

Following surgery, this post-op insulin resistance (PIR) can translate into hyperglycemia, which increases the chance of surgical site infections, as the “sweet environment” invites microbial colonization. Orthopedic patients are at an especially high risk of surgical site infection and joint infections because of the added vulnerability of blood supply to injured or surgically manipulated bones and joints—in addition to the inherent risk associated with implantation technology. The two main potential infection sites are broken bones and the area of surgical incision.

The solution ClearFast provides: Reduced risk of Hyperglycemia and Infection

Liquid fasting for orthopedics patients assures nutrition, hydration and maintenance of electrolytes. It effectively protects or spares critical glycogen stores. Nourishing orthopedic patients with a preop drink like ClearFast in the immediate pre-op window will stabilize blood sugars—ultimately reducing a patient’s risk of hyperglycemia and any associated infection.

Liquid Fasting for Diabetics

The unique problem: Starving a diabetic patient before surgery is extremely dangerous

A prolonged fast ultimately sends a patient’s body into a catabolic state (the body uses up its glycogen stores when it needs energy before surgery and then moves on to breaking down healthy fat and muscle tissue as an alternative energy source). This isn’t ideal for the average healthy patient—let alone for someone managing diabetes. For diabetics, this catabolic state can lead to serious complications—like a diabetic arriving in preop with complications like hyperglycemia and even ketoacidosis. In essence, a prolonged fast before surgery completely ignores—rather than works with—a diabetics’ unique dietary needs, which creates an extremely dangerous environment for surgery. (You can read more about preparing for surgery with diabetes here.)

The solution ClearFast provides: Effectively manages blood sugar levels before, during, and after surgery

Preparing diabetics for surgery with the complex carbs they need for energy helps to ensure their body isn’t using up all of those ever-important glycogen stores. This ultimately helps a diabetic proactively manage his or her blood-sugar levels (rather than being at the mercy of the “from midnight” fast)—reducing their risk of dangerous conditions like pre-op hyperglycemia and ketoacidosis and post-op insulin resistance.

Liquid Fasting for Colorectal/Colonoscopies

The unique problem: Extreme dehydration before surgery + foul-tasting prep liquid

Colonoscopies are one of the most common procedures in the U.S.—and preparing for one is a unique challenge for patients. A pre-op fast from midnight starves and dehydrates every patient, but colonoscopy patients are especially taxed due to the stressful effects of colonoscopy prep. With a prep routine that flushes fluid from the body, patients lose nearly all electrolytes—which is extremely dehydrating and dangerous. Add in the fact that the colonoscopy prep liquid tastes terrible, and you’ve got a recipe for an unnecessarily negative and stressful patient experience.

The solution ClearFast provides: Medical-grade hydration for colonoscopy patients and an easy way to drink the prep-liquid

Clear, colorless and chock-full of complex carbs (as opposed to dyed sports drinks that contain simple sugars), the ClearFast preop drink is a safe solution for properly hydrating and nourishing colorectal and colonoscopy patients. Drinking ClearFast before surgery—especially for colorectal patients undergoing unpleasant prep—assures partial restoration of electrolytes. Easy to drink and delicious when chilled, ClearFast is also a great option for patients struggling to drink the foul-tasting colonoscopy prep liquid, as they can “chase” the prep liquid with the better tasting ClearFast preop drink. Plus, drinking ClearFast before a colonoscopy increases comfort before the procedure and reduces a patient’s risk of post-op nausea and vomiting after their procedure.

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Overall, whether it’s liquid fasting for orthopedics patients, diabetics or colorectal/colonoscopy patients, preparing patients with a complex carb-rich preop beverage like ClearFast can successfully address each of the unique challenges and inherent risks associated with a number of procedures across an array of medical fields. Whether you’re a patient looking to properly nourish and hydrate before surgery, or a medical provider seeking safer surgeries and better surgical outcomes, you can order your ClearFast Preop Drink here to help you achieve surgery success! And, as always, reach out to the ClearFast team at support@drinkcf.com if you have any questions about our preop drink at all.

Stop Fasting Before Surgery: The Surgery-Smart Shift Taking Place Across the Medical Field

We get this question all of the time: Should I fast before surgery? You’d probably be surprised to learn that doctors are beginning to answer that all-important question with a resounding NO. (And we second that!) More and more so, modern medical research is pointing to the fact that fasting before surgery is not exactly the best advice to dish out to patients anymore. Today, we’re talking why this is the case and what you should do to properly prep for surgery instead. We’ll cover:

• Why fasting before surgery is outdated
• Preparing for surgery with clear liquids instead
• The benefits of prepping for surgery with the right clear liquids

Now, let’s dig in…

Should I fast before surgery?

While you should always follow your doctor’s surgery prep instructions, time and time again, modern research points to the fact that medical professionals should no longer instruct patients to fast before surgery and instead should instruct them to carb-load with a clear, specially formulated pre-op drink.

It’s Common Sense…

So why the shift? Let’s start with the common-sense factor:  your body is preparing to undergo some serious stress (surgeries, no matter how simple or quick, always put stress on our bodies, after all), AND on top of that, you’re supposed to enter into that scenario starved and dehydrated?

It doesn’t make much sense when you think about it.

You wouldn’t starve yourself in the hours leading up to a big hike, long bike ride, or marathon. You wouldn’t deprive yourself of nutrition right before a big test or game day. Surgery is more stressful on our bodies than any cycle ride, hike, marathon, or game day—so it makes sense that medical professionals are realizing we need to properly prep our bodies for the inevitable stress we’ll undergo during surgery…rather than depriving our bodies of the things they need most (hello, nutrition and hydration!).  

The research is clear…

Let’s start by talking about the reason doctors once prescribed fasting before surgery, a practice that dates back over 150 years: research papers were once published that led medical professionals to realize having food in your stomach before surgery could cause you to aspirate (aspiration is essentially the entry of your stomach contents/food into the lower respiratory tract and lungs, which can be very dangerous during surgery). Because of this, medical professionals implemented a sweeping rule: no food or drink after midnight before surgery (commonly known as the “NPO after midnight” rule).

By the year 2000, however, a collection of over 30 independent studies proved that patients who drank clear fluid before surgery actually had emptier stomachs than those who didn’t eat or drink anything—which ultimately reduced their risk of aspiration. In fact, an article published by the University of Minnesota Health Center in 2015 states, “A number of studies show that patients do much better if they’re allowed to drink up to two hours before surgery. They use less IV fluid, and depending on what they drink, they have better metabolism. It’s also less difficult to control a patient’s sugar levels following surgery.”

What should I do instead of fasting before surgery?

Instead of fasting before surgery, medical professionals recommend hydrating and nourishing with a clear liquid that contains at least 45 grams of complex carbs (and no simple sugars, like those found in sports drinks) and that has an osmolarity level that allows for timely gastric emptying (in other words, the beverage needs to be formulated to clear from your stomach fast).

ClearFast is the only domestically produced pre-surgery drink of this kind: it’s rich in maltodextrins and healing properties (zinc & L-citrulline), is clear and colorless, is free of simple sugars and colored dyes (like those found in sports drinks) and is trusted by medical professionals across the US, who regularly use ClearFast as a key part of preparing patients for surgery (not to mention it’s pretty darn tasty and gluten-free, too!).

What are the benefits of drinking a clear liquid before surgery instead?

Drinking ClearFast not only makes for a less stressful surgery experience, but it also:

• Reduces your risk of post-op nausea and vomiting
• Reduces dehydration and hunger
• Makes for easier, less painful IV “sticks”
• Gives you an edge on recovery  

Alright, I want some ClearFast for my surgery!

Ready to wake up from surgery feeling strong and recovery-ready…rather than sick to your stomach, stressed, and dehydrated? Talk to your doctor about ClearFast and then order your ClearFast Preop Drink here to get a major leg up on the dreaded surgery and recovery process. And, as always, don’t hesitate to reach out to the ClearFast team at support@drinkcf.com if you have any questions at all.

Every day, we’re learning more about why fasting before surgery isn’t a physician’s friend. More and more modern medical research is leading hospitals and medical professionals to one conclusion: they have to hydrate and nourish their patients before surgery for better outcomes.

Inevitably, some people immediately think of sports drinks for pre-surgery nourishment and hydration—but the truth is sports drinks don’t even come close to cutting it. They’re inadequate for enhanced recovery, don’t nourish, aren’t clear & colorless, and have a high osmolarity that delays gastric emptying (which reintroduces the danger that the traditional “no food or drink after midnight” rule was trying to avert). Plus, not only is the osmolarity higher, but the standard size sports drink is 20 oz vs. ClearFast’s 12 oz. Learn more about ClearFast’s benefits (as compared to leading sports drinks below), and be sure to check out our blog post on why sports drinks don’t cut it for enhanced recovery.

Lowering Stomach Acidity and Increasing Patient Safety with Fluid Fasting

In recent years, an increasing number of clinical studies point to the fact that medical professionals should transition away from the traditional NPO fasting policy and instead encourage proper fluid fasting with an enhanced recovery drink. Today, we’ll cover:

• The benefits of fluid fasting with carbohydrate-rich clear liquids like ClearFast as it relates to reducing gastric acidity
• How ClearFast works to raise the pH in a patient’s stomach, leading to lower gastric acids and, ultimately, a reduced risk of aspiration under anesthesia
• Increasing patient safety with ClearFast in place of traditional NPO fasting
• Pre Op Carb Loading for enhanced recovery and reduced PONV

Now, let’s dig in…

Traditional NPO Fasting Versus Fluid Fasting: Debunking Common Misconceptions

Findings from a Cochrane Collaboration review of preoperative fasting states, “Fasting before general anaesthesia aims to reduce the volume and acidity of stomach contents during surgery, thus reducing the risk of regurgitation/aspiration.” Per this statement, we know that the goal of traditional NPO fasting is to reduce gastric contents, ultimately reducing the risk of aspiration. A misconception surrounding fluid fasting is the belief that a fluid fast increases these risks; however, findings from the Cochrane Collaboration Review debunk this common misconception. An analysis of 38 randomized controlled comparisons found “no evidence that the volume or pH of participants’ gastric contents differed significantly depending on whether the groups were permitted a shortened preoperative fluid fast or continued a standard fast.”  In short, fluid fasting with traditional liquids (like coffee, water, fruit juice, etc.) prior to anesthesia, in no way, posed a risk to a patient’s safety.

Increased pH, Lower Gastric Acidity with ClearFast

Not only have recent studies shown that fluid fasting does not pose a threat to patient safety, but we’ve also learned that preparing patients for anesthesia with the right carbohydrate beverage can actually increase patient safety as compared to traditional “nothing after midnight” fasting.

Patients entering surgery after a two-bottle protocol of ClearFast have higher pH levels (and, thus, lower acidity) of stomach contents. Traditional NPO fasting caused a build up of gastric acids, with an average patient pH level of approximately 2.0. With a pH level of 4.2, ClearFast works to raise the pH in a patient’s stomach, leading to lower gastric acids and, ultimately, a reduced risk of aspiration under anesthesia.

Pre Op Carb Loading for Enhanced Recovery After Surgery

In addition to ClearFast better preparing patients for anesthesia and increasing safety during surgery, we also know that taking ClearFast as directed can lead to enhanced recovery after surgery, as well as a reduction in post op complications like PONV. In 2011, the American Society of Anesthesiologists® updated its fasting guidelines, ultimately advocating not only for pre-surgical hydration, but also nutrition (excluding fats and proteins as known retardants of normal gastric emptying), noting that patients should not be allowed to come to surgery in a hypoglycemic state. ClearFast helps patients maintain metabolic order by both hydrating and nourishing.

In addition to the AMA’s guidelines, we can look at Enhanced Recovery After Surgery or ERAS (an evidence-based program, borrowed from Europe and the UK), which lists “true pre-op carb loading” as one of the 17 key elements for perioperative patient management. The key to the pre-op carb loading element, however, is preparing patients with complex carbohydrate-rich beverages that contain primarily maltodextrins, rather than simple sugars like the fructose found in Gatorade. To these ends, ClearFast is the only domestically produced beverage of this kind (rich in maltodextrins, clear and colorless, free of simple sugars and colored dyes) used in Enhanced Recovery Protocols in luminary hospitals across the USA.

Interested in learning more about the benefits ClearFast can bring to your patients and your practice? Reach out to the ClearFast team today at support@drinkcf.com, or order ClearFast here.

When it comes to carbohydrate loading and enhanced recovery, preparing patients with a complex-carb rich, clear preop drink like ClearFast has been shown to not only reduce muscle breakdown, but lower infection rates. You need warmth to help your muscles relax quickly and a warm decken plaid is best.

Starved patients are much more likely to experience insulin resistance (higher chance of SSI) and muscle breakdown which can cause readmissions and increased costs to health service providers.

The ASER and POQI joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery concludes, “Inclusion of carbohydrates in preoperative oral fluids is likely to improve insulin sensitivity (particular when complex carbohydrates are used) and may reduce protein catabolism.”

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