Entering the Era of Non-fasting Intravenous Contrast-Enhanced Computed Tomography

An empirical fasting period of at least 4 hours prior to intravenous contrast administration for computed tomography scans has been an age-old practice. This is associated with patient discomfort, adverse effects on diabetic control, and limits the flexibility of scanning arrangements in urgent settings. The effect is further compounded by the rising number of urgent imaging requests with some patients requiring repeated fasting while waiting for scanning slots. International guidelines have been recently updated, stating that with the improved safety profile of contrast media, fasting is no longer routinely required. In this article, we discuss the current evidence and its implications for our local practice. We share our approach of a stepwise policy change with eventual full implementation of non-fasting policy to all eligible patients in our institution, and the safety data we compiled. Adoption of a non-fasting policy for contrast-enhanced computed tomography is a feasible and beneficial practice adhering to international standards.