L8 Instrumental Ax Flashcards
What is the purpose of VFS
- an adjunct to clinical Ax
- determine impairment of oral, pharyngeal, laryngeal and upper esophageal function
- help determine a management plan (benefit of compensatory/treatment strategies)
In VFS, x rays are absorbed differently depending on density. Black = __________. White = ____________ and grey = __________
bone/bolus
air
muscles/cartilage
What is the main reason VFS indicated?
When the test is necessary to determine a management plan for the patient
What are the specific indications for VFS
- inconsistent/incomplete clinical ax findings
- high risk for dysphagia/ client aspiration
- potentially compromised safety & efficiency
- identify techniques and strategies for tx
- suspected change in swallow
- nutritional or pulmonary compromise
- help confirm medical diagnosis
- cognitive or communicative deficits that preclude clinical Ax
What are contraindications for VFS?
- clinical exam doesn’t suggest dysphagia
- patient too medially unstable
- pt unable to participate or be adequately positioned
- wouldn’t change tx recommendations
- pt not cleared for oral intake
what do you do if VFS is needed but not available
-consult with IP team and pt and family to develop plan that takes into accounts risks and benefits of various tx options
What information do we get from a VFS?
- details of oral, pharyngeal and upper esophageal swallow
- structural abnormalities
- timing or reaction to bolus flow or presence
- safest and most efficient route for nutrition/hydration (PO vs NPO)
- safety of textures, volumes, oral intake methods and self feeding
- impact on functional and psychosocial aspects
- Rx for treatment
- likelihood of improvement
What does ALARA stand for? what 3 things factor in?
As low as reasonable achievable
- time
- distance
- shielding
What is important when setting up VFS environment
1) ensure radiation safety
2) allow for stable patient postures
3) maximize efficiency
when ensuring radiation safety, you must protect the ________ and the ________
clinician
patient
For the patient, max radiation exposure time should be
< 5 min
In order to reduce patients does of radiation, what should you do
- maximize distance from tube and minimize distance from to image receptor
- minimize time on high magnification
- use gonadal protextion
Who needs to be in the room for the VFS?
- patient
- SLP
- Medical radiation technologist
When using barium in VFS, we need to be aware that it is
sticky
What is the overall VFS protocol?
1) position patient
2) lateral plane
3) anterior/posterior plane
Before food presentation in VFS, you must do what?
- observe all borders simultaneously
- observe bony, soft tissue & any movements at rest
What are the 2 original food presentation protocols?
- rigid (thin to thick)
- patient driven (start with what patient is currently eating)
Overall what are the 2 main purposes of VFS
- determine physioogy
- determine any remedial strategies that can make swallow better
Briefly describe scintigraphy
provides quantitative info about passage of radio nucleotide through the body, allows us to observe bolus movement in pharyngeal of pulmonary tract
Briefly describe ultrasonography
sound waves are reflected off tissues onto monitor
Briefly describe auscultation
listening to sounds of breathing, swallowing or bolus passage by placing stethoscope over throat
-abnormal sounds detect pharyngeal dysphagia
Briefly describe manometry
catheter passed nasally into pharynx to record luminal pressures. Detects palatal closure and pharyngeal wall movements
