Nil by Mouth (NBM)

When the swallow mechanism is not working efficiently saliva, food,
drink and medications may go down the wrong way entering your
airway and lungs. This is known as “aspiration”.
As a result you may cough and splutter or choke after eating /
drinking or on your own saliva. These are some of the signs of
aspiration. Some people do not show obvious signs of aspiration and
this is referred to as “silent aspiration”.
This is because swallowing is a complicated process, involving a
series of muscles working together quickly to ensure food, drink and
medications are safely transported from your mouth to your stomach.
If food / fluids continue to enter your airway and lungs, this can lead
to chest infections or aspiration pneumonia. This can be a serious
life threatening condition. It may also lead to weight loss, dehydration
and malnutrition.
You may be asked to be ‘Nil by Mouth’ if you are going to have
surgery or a clinical procedure, especially if you are going to have a
general anaesthetic. This can be due to the possibility that you may
be sick or regurgitate the food or drink you have eaten and this may
end up in your lungs.

If you cannot swallow very well or someone has observed or
suspected that you are having trouble swallowing, a Speech and
Language Therapist (SLT) may be asked to assess your swallow.
As a result of this assessment you may be informed that you need to
be NBM to prevent further risk of aspiration (breathing food and drink into your lungs).

There may be several options:

1. You may need to have a short term alternative way to provide
your body with nutrition or hydration via a feeding tube or be
given fluids via a drip. You can also receive medications this
way. If required this will be discussed with you and/or your family
by the multi-disciplinary team (MDT) i.e. a doctor, ward nurse,
pharmacist, dietitian and SLT.
2. The SLT may continue to assess your swallow whilst you are in
hospital and will discuss any recommendations with you and/or
your family.
3. If starting to eat and drink again is considered safe, the SLT
and/or medical team may recommend the safest food and fluid
consistencies, for example liquidised food, or soft foods. If your
dietary intake is minimal, the dietitian can discuss strategies with
you and your family to optimise your intake and discuss realistic
expectations of your oral intake.
4. In some cases your ability to swallow safely may not be possible,
and longer term nutrition and hydration planning may be required.
The MDT will discuss with you and/or your family the most
appropriate plan going forward e.g. Eating and drinking at risk’ or
enteral feeding patient (someone who needs to ‘eat’ using a tube)
and provide further guidance and assistance as a result.

Please note: Further assessments of your swallow are sometimes
needed, for example by using an x-ray called a “Videofluoroscopy”
or a “Fibreoptic Endoscopic Evaluation of Swallowing” (FEES), which
assesses the swallow using an endoscope to look into your throat.
During this time the Nutrition Support Team (NST) can be helpful.

Oral hygiene

It is very important to keep your mouth clean to reduce the risk of
mouth, throat and chest infections. If you are too unwell or unable to
do this yourself you may need someone to provide you with help and
support during this time:

• Check and/or clean your mouth every 2 hours. You may be able to
do this yourself or may need to receive assistance to do it for you.
• Make sure you are sitting upright and leaning forward to avoid
toothpaste / secretions falling back into your throat whilst doing
mouth care.
• Add a small amount (pea sized) of fluoride toothpaste to a small
soft toothbrush.
• Clean your teeth and tongue using a toothbrush.
• Continue until your mouth is clean.
• Ensure your mouth is cleared.
• Your lips and oral cavity should be kept moist, using appropriate
products if needed. These products will be supplied by your
nurse or doctor.

Managing saliva

• You may need to be encouraged to swallow saliva if this is possible.
• You may require assistance in the form of suctioning from nursing
or caring staff if you are unable to safely swallow saliva.
• Doctors may prescribe medication to reduce the amount of saliva.
• Please avoid sleeping flat on your back if you have excess saliva.
There is recommendation saying it is best to prop you up with
pillows and lay on your side instead.
• If you are suffering from dry mouth – the doctor may prescribe a
saliva replacement gel / spray.

If you have any questions or require further information please
contact members of the multidisciplinary team involved in your care
e.g. the Ward Doctor, Ward Nurse, SLT or Dietitian.

Useful Numbers                                                                 Internal                          External

Speech and Language Therapy (BTH)                              53873                            01253 953873

Dietetics (BTH)                                                                   56777                            01253 956777

Dietetics (Clifton Hospital)                                                  56237                            01253 956237