Bill has had his swallow screen completed by the nursing staff and has been reviewed by a Speech and Language Therapist who has completed his swallow assessment. Bill is not recommended to have any oral food or fluids currently and is nil by mouth (NBM)
When a person’s swallowing is unsafe or under review by a Speech and Language Therapist, there are a number of alternative hydration and nutritional options available for consideration. Each case should be considered on an individual basis taking into account the individual’s acute medical state, consent and cognition.
Bill and his family would like to know what options are available to him regarding his nutrition and hydration if his swallow remains unsafe.
| Nutrition and hydration options | |
| Oral intake | If the swallow screen and swallow assessment are safe oral intake should be started. The person should be observed and the SLT will recommend a textured diet if required |
| Intravenous infusion (IV) | This only provides fluids and will not provide you with any of the nutrition you need. This is a short term option |
| Subcutaneous infusion (SC) | This only provides fluids and will not provide you with any the nutrition you need. This is a short term option and may be used when venous access is difficult or when small volumes of fluid are needed for comfort e.g end of life |
| Nasogastric feeding (NG) | If oral intake is insufficient and likely to be so for > 1-7 days. This is the placement of a tube through the nose, down the throat, and into the stomach. It is usually the first option for feeding somebody who has had a stroke, if they are unable to swallow. |
| Gastrostomy
(e.g. PEG) |
This is considered if a NG has been in place for 3-4 weeks and there is little or no improvement in their swallowing ability. This is done by endoscopy and requires sedation. A tube is placed directly through the stomach wall and into the stomach to provide food and fluids. |
| Parenteral Nutrition (PN) | This is a type of feeding directly into the person’s vein, bypassing the usual process of eating and digestion. It is only used if GI tract is not accessible or functioning. |
| Eating and drinking with accepted risk | In some circumstances, artificial nutrition and hydration is not wanted or appropriate, therefore there is an option to eat and drink with accepted risk. This may be chosen when the patients quality of life would be affected by not eating and artificial nutrition may not enhance their quality of life. The risks include choking on diet and fluids which can be serious and life threatening. This is discussed with patients, families and their healthcare team when appropriate. |
The Speech and Language Therapist has a discussion with Bill and his family about carrying out a videofluoroscopy, an instrumental assessment using x-ray equipment, to provide a more detailed assessment of the swallow and Bill consents to this.
Page last reviewed: 03 Jun 2021
