How do you prevent aspiration when swallowing?
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Aspiration occurs when food or saliva enters the airway and lungs. Aspiration can cause pneumonia, or lung infection which causes shortness of breath, and lead to other infections and possibly death. There are numerous reasons for aspiration and it is best to treat the cause of the aspiration. Show
Symptoms of aspiration include: Coughing while eating Evaluation for aspiration includes: Laryngoscopy and stroboscopy – The treating physician should ensure that a vocal fold paralysis or any other anatomic conditions are not the cause of aspiration. A swallowing study including a modified barium swallow study or a flexible endoscopic evaluation of swallowing may be performed to confirm the diagnosis of aspiration. During a modified barium swallow study, swallowed contents may be seen to travel between the vocal folds into the lungs. During flexible endoscopic evaluation of swallowing colored food products may be seen to travel into the trachea. Treatment of aspiration may include: Dietary changes – Thicker foods such as applesauce are easier to swallow and more difficult to aspirate than thin liquids such as water. Adding thickener to foods may make it easier to swallow. Swallowing therapy – a speech pathologist works with a patient to strengthen the muscles of swallowing and teach good habits during eating that may minimize aspiration. Tracheotomy – A tracheotomy does not treat the cause of the aspiration; however it may assist in two ways.
Gastrostomy tube placement – In some individuals food and liquid that is swallowed enters the airway easily. A stomach tube, or G tube, is surgically placed to allow feeding to occur, bypassing the mouth throat and larynx. Laryngectomy – In this surgery the voice box is removed and a permanent tracheotomy is created. The respiratory and digestive tracts are separated and food and saliva can longer enter the airway. Removing the voice box prevents a patient from speaking normally – however, alternative mechanisms of speech are possible to perform which are very intelligible. Laryngotracheal separation – In this surgery a tracheotomy is performed. The trachea above is closed off. This also removes a person’s normal ability to speak. In theory, this is a reversible procedure. Every good nurse knows that the job involves much more than simply treating the patient’s current illness or injury. Instead, nurses should try to anticipate potential complications that could arise for their patients and implement measures to prevent them from happening.Preventing aspiration pneumonia is one example. Studies suggest that patients with aspiration pneumonia have a higher morbidity and mortality than those with community-acquired pneumonia. Let’s take a look at some strategies that nurses can employ to help their patients avoid this dangerous syndrome.
1. Identify patients at high riskTechnically, any patient can aspirate, but most healthy individuals can tolerate small amounts of aspirated material with little effect. However, certain patients are at higher risk to aspirate and develop complications. This includes those who:
Recognizing those at high risk allows the nurse to take proactive precautions. 2. Consider the effect of patient medicationsSeveral medications increase the likelihood of aspiration. Sedatives are the most commonly implicated, but it is important to be aware of the others. Opioids, hypnotics, anti-anxiety medications, and muscle relaxers can affect the patient’s ability to swallow. Anticholinergics and calcium channel blockers relax the esophageal sphincter. Alcohol, anticholinergics and anesthetics can affect a patient's ability to cough and gag. It may be helpful, if appropriate, to discontinue or decrease these medications. However, when this is not possible, patients should be closely monitored. 3. Perform oral careWhen oral hygiene is performed regularly, it decreases the amount of oral bacteria. Less bacteria in secretions lowers the risk of infection.
4. Modify oral intakeAllowing patients to eat in a relaxed environment without distractions may be helpful in minimizing aspiration. Patients should also be fed smaller amounts at a time. Patients with difficulty swallowing may need the consistency of their food modified so that it is safer and easier to eat. Thickened liquids or alternating solid and liquids may be better tolerated. Sticky, stringy, dry and chewy foods should be avoided. Dairy products may also cause difficulty since they may cause an increase in mucous. 5. Consider a team approachSpeech and occupational therapy can be very helpful. Having patients work with these disciplines to improve their swallowing technique and strengthen the underlying physiology may decrease the risk of aspiration. Proper positioning and the use of special adaptive feeding tools should also be addressed. 6. Make sure suction is availableFrequent suctioning of oropharyngeal secretions may be needed for patients who have difficulty swallowing or coughing to clear their airway. In-wall or portable suction should be properly set up and ready to go for these patients. Monitor patients while feeding. If any signs of aspiration are noted, the patient should be suctioned immediately. Aspiration pneumonia can be a very serious medical condition, especially for patients who are already compromised. By incorporating these interventions into their patient care, nurses can help prevent this dangerous complication.
References Lanspa, M. J., Jones, B. E., Brown, S. M., & Dean, N. C. (2012). Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J. Hosp. Med Journal of Hospital Medicine, 8(2), 83-90. doi:10.1002/jhm.1996 Smith, L. H. (2009). Preventing Aspiration: A Common and Dangerous Problem for Patients With Cancer. Clinical Journal of Oncology Nursing, 13(1), 105-108. doi:10.1188/09.cjon.105-108
Editor's note: This blog was originally from May 2016. It has been re-published with additional up to date content. How can you prevent aspiration in older adults with dysphagia?PREVENTION OF ASPIRATION DURING HAND FEEDING:. Sit the person upright in a chair; if confined to bed, elevate the backrest to a 90-degree angle.. Implement postural changes that improve swallowing. ... . Adjust rate of feeding and size of bites to the person's tolerance; avoid rushed or forced feeding.. What causes aspiration before the swallow?Aspiration before the swallow is commonly caused by either premature entry of liquids into the pharynx (due to impaired containment in the oral cavity) or by delayed onset of laryngeal closure after a bolus is propelled into the pharynx.
What is the best position to prevent aspiration?The risk of aspiration pneumonia increases as mobility and the ability to independently position oneself decreases. The person may benefit from being elevated (in upright position and/or with their head up), including when being changed, bathed, or in bed, and not just when eating or drinking.
What is the most common cause of aspiration?Usually, it's food, saliva, or stomach contents that make their way into your lungs when you swallow, vomit, or experience heartburn. Aspiration is more common in older adults, infants, people who have trouble swallowing or controlling their tongues, and people who are intubated.
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