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Trachs & Vents > Trach & Swallowing > Flashcards

Trach & Swallowing Flashcards

1
Q

There is a complex interrelationship between ___________ and ___________.

A

Deglutition & respiration

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2
Q

Is there potential for the presence of the trach tube to impact swallowing?

A

Yes, however, it is not absolute.

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3
Q

Is there potential for the occlusion status of the trach tube to impact swallowing?

A

Yes, however, it is not absolute.

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4
Q

Factors influencing airway protection in patients with pulmonary disease include: (3)

A
  • Alterations in the timing of airway closure
  • Interruption of the normally well timed pattern of swallowing & breathing
  • Diminished respiratory defenses (ex: cough, airway clearance)
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5
Q

When respiratory system is stressed, the duration of the inspiratory phase is _______ and the time requirement for airway closure is _________.

A

Reduced; disrupted

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6
Q

Patients with ____ ______ pulmonary disease may required a ___________ ____.

A

more severe; tracheotomy tube

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7
Q

What is the normal pattern of swallowing and breathing in the average patient?

A

95% of all swallow were followed by an exhalation

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8
Q

What is the pattern of swallowing and breathing in patients with a CVA?

A

CVA patients inhaled immediately after the swallow

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9
Q

Role of expiratory airflow: timing of the swallow within the expiratory airflow

A
  • Assists w/airway clearance in removing pharyngeal and laryngeal residue
  • When pulmonary air is not available for clearance, aspiration may be more likely
  • Patients on a vent, during VFSS, observed aspirated material clear airway upon exhalation
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10
Q

When alone could be the main contributing factor to a swallowing disorder?

A

Underlying medical condition in the 1st place alone could be the main contributing source of the swallowing disorder (ex: pulmonary conditions, neurological diseases, etc.)

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11
Q

What are the mechanical impacts of a trach tube? (2)

A
  • Reduced laryngeal excursion

- Saliva & secretion management

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12
Q

Mechanical impact of the trach: reduced laryngeal excursion (4)

A
  • Anchoring effect
  • Decreased BOT movement (deconditioning)
  • Weight of equipment
  • Cuff inflation/over inflated cuff
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13
Q

Mechanical impact of the trach: saliva & secretion management

A

-Medication side effects

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14
Q

What are the physiologic impact of the trach on swallowing? (2)

A
  • Disruption of airway pressure

- Reduction of airflow through the glottis

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15
Q

Physiologic impact of the trach: disruption of airway pressure

A

-Occlusion status

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16
Q

Physiologic impact of the trach: Reduction of airflow through the glottis

A
  • Without expiration through the glottis, redued ability to clear residual materials from airway
  • Loss of laryngeal sensation
  • Glottis closure response - reduced coordination
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17
Q

Suiter et al. found what about cuff deflation for incidence & severity of aspiration

A

Cuff deflation DID NOT reduce incidence or severity of aspiration as compared w/the cuffed or one-way valve

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18
Q

Suiter et al. found what about cuff deflation and hyolaryngeal excursion?

A

An increase in extent of hyoid maximal anterior movement was observed w/cuff deflation. However, No significant increase in maximal laryngeal elevation was noted.

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19
Q

Suiter et al. found what about one-way valves and aspiration?

A

Use of one-way valve REDUCED incidence & severity of aspiration of thin liquids

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20
Q

What is the potential reason for improvement in swallow due to one way valve?

A

Re-establishment of sub glottal air pressure – really, remains unclear though

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21
Q

Suiter CONCLUSION: Patients who are able to tolerate cuff deflation and one-way valve placement MAY …

A

benefit from eating w/a one-way valve in place.

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22
Q

Suiter CONCLUSION: May see improvement with patients with …

A

difficulty with thin liquids

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23
Q

Suiter CONCLUSION: Use of valve will…

A

NOT ALWAYS improve swallow function

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24
Q

Does an inflated cuff prevent aspiration?

A

NO

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25
Q

If the cuff is over-inflated, you have a potential for…

A

tracheal wall breakdown

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26
Q

At times, patients may be permitted to eat w/an inflated cuff given a variety of other factors that may come into play (2)

A
  • Individual / case by case situation

- Recommended proper suctioning protocols

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27
Q

Pre & post trach effect:

A
  • 12/12 subjects who aspirated before the trach also aspirated after
  • 7/8 subjects who did NOT aspirate before the trach also did NOT aspirate after
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28
Q

Is there is casual relationship between trach and aspiration status?

A

Confirmation of NO casual relationship between trach & aspiration status

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29
Q

trach effect: removal of the trach

A

-No differences in aspiration status w/the trach tube in, removed with the tracheostoma gently covered, or with an open tracheostoma

30
Q

Does research (Terk, Ledler & Burrell) show evidence to support that the trach tube tethers the larynx during the swallow?

A

No evidence under the following 3 conditions:

  • Trach tube in w/inflated cuff
  • Trach tube in w/capped w/deflated cuff
  • Trach tube out (decannulated)
31
Q

Swallowing following prolonged endotracheal intubation (>48 hours)

A

~36%-70% aspiration

32
Q

Effects of mechanical vent on swallowing: Terzir – swallowing on / off the vent

A

Reduced swallowing time per bolus & number of swallows per bolus when swallowing ON the mechanical ventilator

33
Q

Effects of mechanical ventilation on swallowing: Vitacca – Swallowing may ________ work of respiratory muscles where mechanical ventilation had the ________ effect.

A

Swallowing may INCREASE work of respiratory muscles where mechanical ventilation had the OPPOSITE effect.

34
Q

Effects of mechanical ventilation on swallowing: Vitacca – Mechanical ventilation maintains a _______ subglottic pressure to ______ the risk of aspiration.

A

Mechanical ventilation maintains a POSITIVE subglottic pressure to REDUCE the risk of aspiration.

35
Q

Vent dependent & Trach: aspiration present in ___% of patients. (___% was silent)

A

Davis & Stanton: 41.4% aspiration - 83.3% silent

Leder: 33% aspiration - 82.3% silent

36
Q

Vent dependent & trach: compensatory strategies alleviated aspiration in ___% of the patients.

A

63.8%

37
Q

vent dependent & tach: aspirations were _____ and _____ days post-trach

A

Older & fewer days post-trach (73 y/o vs 59 y/o – 14 days vs 23 days)

38
Q

Types of blue dye (5)

A
  • Evan’s blue dye
  • Methylene blue dye
  • Isosulfan blue dye
  • FD & C Blue No. 1 **
  • FD & C Blue No. 2
39
Q

What is the most common type of dye used for enteral feedings to detect for pulmonary aspiration?

A

FD & C No. 1

40
Q

FD & C No. 1 is relatively non-toxic as less than ___ is absorbed systematically.

A

5%

41
Q

Acceptable daily human intake of FD & C Blue No. 1 is ___ milligrams per kilogram of body weight

A

12.0 milligrams / kilogram of body weight

42
Q

Patients who are risk for the use of FD & C Blue No 1. have increased _______________ __________.

A

Gastrointestinal permeability (ex: sepsis, burns, shock, multiple trauma, renal failure, inflammatory bowel disease, surgical intervention, bowel disease / celiac sprue disease)

43
Q

No adverse reports published regarding using blue dyed foods with ________________ patients during ___________________.

A

Non-critically ill patients; swallowing evaluations

44
Q

At this time, the FDA (has/has not) come out with a specific warning against using blue food coloring during swallow evaluations.

A

HAS NOT

45
Q

Is green dye any safer than blue?

A

NO

46
Q

Who was the first to investigate the efficacy of dying enteral feedings blue as a mean to detect pulmonary aspiration?

A

Potts et al (1993)

47
Q

Potts et al (1993) - inspecting tracheal secretion ______ to detect most episodes of known aspiration.

A

FAILED

48
Q

Methany et al. (2002) used animal model how?

A

Using rabbits and forcing small-volume pulmonary aspiration

49
Q

The efficacy of blue dye with tracks was first described by…

A

Cameron et al (1973)

50
Q

Blue Dye Swallow Clinical Swallow Screening (Steps)

A
  • 3-5 drops of blue food coloring placed into a 4oz cup of puree / liquid
  • Complete standard clinical swallow eval (chart review, oral mech, cog status, etc)
  • Deflate cuff if possible
  • Occluse end of trach tube if possible
  • Have suction set up
  • Provide pt w/1 consistency of food/liquid that hs been dyed
  • Observe pt’s reaction to bolus presentation
  • Provide w/additional presentations of same consistency (3-5)
  • Provide suctioning and observe for blue tinged secretions
  • Change trach dressing around stoma site and observe for blue discoloration / tinged mucus
  • If pt has dual cannula system: remove inner cannula to look for blue content
  • Return pt to baseline occlusion & cuff status
  • Document exact steps / results
51
Q

How do you know if the blue dye test has positive findings?

A

If you see blue in the suctioning catheter, around the stoma site, or on the inner cannula of the trach tube.

52
Q

How long after the blue dye swallow screen do you monitor suctioning records for?

A

Monitor suctioning records for the next 8-24 hours.

53
Q

Blue dye test showed an overall false-negative error rate of __% for the detection of aspiration when compared to VFSS & FEES

A

50%
(100% accurate to detect aspiration in gross amount -VFSS study — 67% accurate to detect aspiration in gross amount -FEES study)

54
Q

The blue dye test is NOT sensitive to detect _______________, only sensitive to detect ________________.

A

microaspiration; gross aspiration

55
Q

Current evidence suggest that the blue dye test should, at best, be viewed only as a ___________ for the presence of gross amounts of aspiration.

A

Screening tool

56
Q

The blue dye test is like what for a patient with a trach or someone is NPO?

A

A clinical bedside swallow eval

57
Q

If the patient has a positive blue dye test, what are some things to consider?

A

Take them for an instrumental to see how much they’re aspirating, to trial compensatory strategies, and test consistencies

58
Q

If the patient has a negative blue dye test, what are some things to consider?

A

Do NOT recommend a diet based on this result - you’d still want an instrumental assessment to confirm they are not aspirating

59
Q

Trach Effect? - Removal of the trach on the swallow - procedure:

A
  • pt provided with 3 boluses of puree WITH the trach tube in place
  • Trach removed & stoma covered w/gauze & gentle hand pressure
  • Pt presented with 3 boluses of puree WITHOUT the trach tube in place
  • Subglottal viewing also completed
60
Q

Trach Effect? - Removal of the trach on the swallow - Results:

Aspiration status was in agreement with and without the trach in place in __% of the subjects.

A

95%

61
Q

Trach Effect? - Removal of the trach on the swallow - Results:

Aspiration occurred with the trach tube in place in __% of subjects

A

8%

62
Q

Trach Effect? - Removal of the trach on the swallow - Results:

Aspiration occurred with the trach tube removed in __% of the patients

A

13.5%

63
Q

Trach Effect? - Removal of the trach on the swallow - Results:

The 2 patients who demonstrated a different swallowing pattern with regard to aspiration, only demonstrated aspiration when the trach was _______.

A

Removed.

64
Q

Trach Effect? - Removal of the trach on the swallow - Results:

Laryngeal penetration occurred in ___% of the subjects with and without the trach

A

67.6%

65
Q

Trach Effect? - Removal of the trach on the swallow - Results:

Laryngeal penetration status was in agreement w/ and w/out the trach in place in __% of the subjects.

A

78%

4 pts. did better with the trach, 4 pts did better without the trach

66
Q

Trach Effect? - Removal of the trach on the swallow

For a majority of the patients, the removal of the trach tube made ___________ in the incidence of aspiration/laryngeal penetration.

A

No difference

67
Q

Do the results of the trach effect (removal of the trach) study support the clinical notion that swallow function will improve with the removal of the trach tube?

A

NOPE

68
Q

What is one limitation of the trach effect study? (removal of the trach)

A

Only puree consistencies were evaluated - may see a difference when it comes to liquids

69
Q

Durational analysis for swallow initiation time and duration of laryngeal closure (were / weren’t) significantly different by occlusion status or after the removal of the tracheotomy tube.

A

WERE NOT

70
Q

MarionJoy results regarding occlusions condition and swallowing:

A

Open: 16% demonstrated increased airway invasion
Finger: 10.7%
Capped: 5.35%
*No clear pattern though - multifactoral problem

71
Q

Patients should be evaluated under ________________________ to determine the optimal conditions to facilitate a safe swallow in this patient population.

A

a variety of conditions

Trachs & Vents (3 decks)

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