S1247 Restricting Routine Use of Intravenous Fluid Before Outpatient Endoscopy Does Not Increase Adverse Outcomes

Introduction: Gastrointestinal endoscopy (GIE) procedures, which include esophagogastroduodenoscopy (EGD) and colonoscopy, account for the most procedures performed in ambulatory surgery centers (ASC). Though clinical guidelines do not support routine administration of intravenous IV fluids, many ASC's routinely administer intraprocedural IV fluids to all patients. The national shortage of saline caused by Hurricane Helene in September 2024 provided an opportunity for our large, community based ASC's that routinely administer IV fluids for GIE to evaluate the safety of a protocol of restricting intraprocedural IV fluids only to higher risk patients. Methods: Historically, all ASC patients undergoing GIE would receive IV fluids at the practice. In response to the national saline shortage, we adopted a restrictive IV fluids protocol in September 2024. Under this protocol, IV fluids were limited to patients aged 70 or older, diabetics or those undergoing double procedures (DP) (EGD and colonoscopy), and those who were dehydrated in the assessment of the anesthetist. Rescue IV fluids were given at the anesthetist's discretion, including for clinical signs of hypotension, which was defined as sustained decrease in systolic blood pressure to <90 mm Hg, or transient decrease on 2 separate occasions. Demographic data was recorded and all adverse events were tracked for patients in the restrictive IV fluids protocol until discharge, including need to administer IV fluids within or after the procedure. Results: Over 5 months, 4853 GIE were completed, including 3713 colonoscopies, 580 RGD's, 557 DP's and 3 sigmoidoscopies. Of these 2792 (58%) met criteria for the restrictive IV fluids protocol. 103 patients (3.7%) had hypotension during or after the procedure, and 35 !1.25%) were given IV fluids. Of the IV fluids restricted patients receiving IV fluids, hypotension was the reason in 19 (54%), arrhythmia in 1 (3%), and “other causes” in the remainder. Of the IV fluids restricted patients, fluids were given in response to concerns raised in the post-anesthesia care unit (PACU) in 19 (54%) patients. Sixteen (84%) of the patients received IV fluids in the PACU for hypotension. Conclusion: A protocol restricting IV fluids to older patients, diabetics and those having DP had a low risk of adverse events. While 3.7% of patients had hypotension, this was significant enough to require rescue IV fluids in only 1.25%. There were no serious complications. A protocol of restrictive IV fluids in patients undergoing GIE at ASC's appears to be safe. Our findings are in line with existing data and clinical practice recommendations.