/Appendix 3). Water Swallow Chart Written documentation of the WST must be available for all patients utilising the “Checklist for Swallowing Difficulties inTracheostomised Patients” (see
Immediate return of dye from the tracheostomy is a clear indicator that the patient has aspirated and the WST should be discontinued immediately and Speech and Language Therapy Department contacted.
Click here for instruction on water swallow test part III (follows from part II)Immediate return of dye from the tracheostomy is a clear ndicator that the patient has aspirated. However, there is evidence that, in some cases, the return of blue dye after assessment can be delayed by >24 hours (Dikeman & Kazandjian 1995). In this instance make the patient NIL BY MOUTH and repeat full WST once per day over a 2 day period. If the patient fails the WST over 2 days contact the Speech and Language Therapy Department.
Click here for instruction on water swallow test part II (follows from part I)
The competent healthcare practitioner must ensure that the potential risk for secondary complications are made clear to all personnel.Ideally, oral intake is deferred until cuff deflation is achieved. However, in special circumstances eg quality of life issues a ulti-disciplinary team decision for small amounts of oral intake with partial cuff deflation may be indicated.
Click here for instruction on water swallow test part I
Criteria for cuff deflation must be achieved (see Cuff Deflation Criteria). This decreases the risk of aspiration and facilitates the use of a weaning device. There is evidence that occluding the tracheostomy tube during swallowing may further reduce the risk of aspiration (Leder, Logemann et al 1997).previous problems and can exacerbate difficulties in some patients with existing neurological or mechanical swallowing problems (Murray 1998). There is evidence that the presence of a tracheostomy tube can cause swallowing difficulties in some patients with no
Pre water swallow test assessment
When to consider a referral to a Speech and Language Therapist for swallow assessmentIt is advisable that oral intake should only be considered and offered when the cuff is deflated and a speaking valve or decannulation cap is in place. Patients will require a cuff deflation tolerance test to ensure that they can endure cuff deflation with no adverse signs. This must be assessed by a competent healthcare practitioner. It is recommended that all patients undergo a water swallow test (see appendix 4) to establish their ability to swallow safely before they proceed to other fluids and solids.
Proceed with caution
Oral intake for patient with a tracheostomySpeech and Language Therapists are only involved in the assessment and management of patients with tracheostomies who present with swallowing difficulties. These patients require swallowing screening prior to the commencement of oral feeding, this is to reduce the risk of aspiration which may lead to aspiration pneumonia (Myers 1995). A multidisciplinary approach is recommended to ensure appropriate and effective care for the individual patient.
Not all patients with tracheostomies will have swallowing problems.
It has been documented over the years that the presence of a tracheostomy tube can sometimes adversely effect swallowing in patients who previously had no dysphagia, and may further impair the swallowing function in those who already have neurological or mechanical disorders of swallowing.