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Nil By Mouth Policy - DRAFT
Responsible for policy - Thomas Ind & Paul Quinton
Last reviewed - 22/3/2005
Last date page electronically updated - 28/03/2005
Next review - 1/4/2006
The guidelines apply to patients having procedures under sedation, local anaesthesia, regional anaesthesia (e.g. epidural or Buer’s block) as well as under general anaesthetic. They are intended to minimise the risk of aspiration of stomach contents and also to prevent patients’ being starved and dehydrated for unnecessarily long periods before surgery or missing doses of oral medication.
Patients scheduled for surgery on a morning list (or before 13:30 on an all-day list)
May eat and drink freely until midnight.
May drink suitable fluids* only until 6:00 am.
Must be ‘nil by mouth’ after 6:00 am, except for one large glass (up to 200ml) of water to take tablets (see note 3 below).
Patients scheduled for surgery on an afternoon list (or after 13:30 on an all-day list)
May eat and drink until 7:30 am on the morning of surgery. They may have a light breakfast before this time.
May drink suitable fluids* until 11:00 am.
Must be ‘nil by mouth’ after 11:00 am, except for one large glass (up to 200ml) of water to take tablets or pre-medication (see note 3 below).
*Suitable fluids include tea and coffee (for adults), clear fluids such as diluted squash or water but excludes soups, milk by itself, milk drinks or drinks which are thick or contain solid matter.
Patients Due For EMERGENCY Surgery
Patients due to undergo emergency surgery should be ‘nil by mouth’. However, if the patient is dehydrated, or if a delay of several hours is anticipated, the patient’s hydration must be maintained either intravenously, or orally when appropriate. This should be discussed with the anaesthetist involved.
Notes
Individual surgeons may wish to vary these guideline, for example for patients undergoing gastro-intestinal surgery. In these cases the patient’s condition (e.g. gastro-intestinal disease or pregnancy) may indicate special conditions.
It does not apply to pregnant women who are in their second or third trimester.
Patient’s routine oral medication should as a rule be given as usual with water on the day of surgery. Special consideration should be given to hypoglycaemic agents and anticoagulants which should be discussed with the anaesthetist.
Once an opiate or anticholinergic has been given, patients must be strictly ‘nil by mouth’.
Always consider an intravenous infusion if more than a few hours of ‘nil by mouth’ is unavoidable.
Diabetic patients have special considerations and the appropriate section of this protocol should be read prior to making a ‘nil by mouth’ decision in such cases.
Patients receiving a bowel preparation have special considerations and the appropriate section of this protocol should be read prior to making a ‘nil by mouth’ decision in such cases.