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Archive April 2017 XVIII, No. 4

5 Steps to PONV Prevention

Post-operative nausea and vomiting is one of surgery's most unwanted side effects. Here's how to keep patients' stomachs settled.

Edna Ma

Edna Ma, MD


nausea and vomiting NOTHING'S WORSE Nearly one-fourth (24%) of surgical patients dread post-operative nausea and vomiting more than post-op pain or the IV start, according to the 313 readers Outpatient Surgery surveyed last month.

A case of post-operative nausea and vomiting is bound to leave a bad taste in a patient's mouth, proverbially speaking, even if her surgery is a complete success. From my experience, patients rank PONV as one of the most distressing aftereffects of surgery, even more so than post-operative pain. That's why I consider preventing PONV my No. 1 priority apart from preserving the patient's safety and comfort during the surgery. Here's my 5-point plan designed to make sure patients get discharged with their stomachs settled — and your facility's reputation intact.

1 Know your patient. PONV affects as many as 40% of patients. Preventing it is all about ameliorating the risk based on the patient's history, the nature of the surgery and gender. Young women are more prone to PONV — as much as 3 times more likely than men, in fact. Nonsmokers and anyone with a history of migraines or motion sickness tend to be more at risk, too.

Ask patients if they have a history of PONV, but some patients might not remember or might not even know that they're prone to PONV. So do some legwork on the patient to see if you can learn more. You'll learn more when you speak with the patient directly, so use your pre-operative introduction as an opportunity to uncover more information. When I contact a patient the night before surgery, I'll answer any questions they might have and also ask a few of my own so I can complete a formal assessment to gauge the likelihood of PONV. If the patient is anxious and has a history of PONV, administer an antiemetic like aprepitant or ondansetron. I'll also remind the patient of NPO fasting guidelines, but if their case is later in the day I'll encourage them to take some PO water or, if they have reason to think they might suffer from withdrawal, some coffee.

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