[Dysphagia] RE: oral endotracheal tube--attention ICU hounds!!

[DickersC at summa-health.org (Dickerson, Camille)]

Hello,

My hospital would like to change their anchoring device used in ICU to
the Hollister Oral Endotracheal Tube Attachment Device (E TAD).  One of
the reasons for doing this is to minimize the potential risk of sores
and nerve damage if one is intubated for extended periods of time.

My question is... Does anyone have experience with individuals who have
had this device in   ICU?  If so, have there been any complications?
What were they?  
Is this a superior anchoring system to what is out there? 

This hospital would like to do an analysis (mini-study) when they
implement this device.  One of the concerns that we are trying to
minimize is dysphagia and its severity post intubation. They asked me
and I had no clue about this particular device. So, I'm investigating

Your input would be appreciated.

Gary Motta M.A., CCC-SLP
Private Practice 
Cuyahoga Falls, OH 
877-568-7724
chloroxi@yahoo.com

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of dysphagia-request@b9.com
Sent: Monday, June 13, 2005 2:01 PM
To: dysphagia@b9.com
Subject: Dysphagia Digest, Vol 19, Issue 7

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Today's Topics:

   1. RE: Dry mouth (Kate Milford (CMDHB))
   2. Re: Thickened liquids (Chris and Claire Langdon)
   3. RE: Dry mouth (Hummelbrunner, Jackie)
   4. CVA Research (Christopher Babashka)
   5. lingual frenum (christabel daley)


----------------------------------------------------------------------

Message: 1
Date: Mon, 13 Jun 2005 07:46:00 +1200
From: "Kate Milford \(CMDHB\)" <KMilford@middlemore.co.nz>
Subject: RE: [Dysphagia] Dry mouth
To: "Tricia Clark" <Tricia.Clark@cootharinga.org.au>,
	<dysphagia@b9.com>
Message-ID:
	
<8471221366DFB945B5F0E4DF8E1E89EEF109CA@MMHEXG001.healthcare.huarahi.hea
lth.govt.nz>
	
Content-Type: text/plain;	charset="US-ASCII"

How about using steam to moisturise? Is she a mouth breather?
Also, I would double check that her fluid intake via the PEG is
sufficient for her to be well hydrated.
Kate 

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of Tricia Clark
Sent: Friday, 10 June 2005 18:05
To: dysphagia@b9.com
Subject: [Dysphagia] Dry mouth

Hello everyone
 
Just wondering if someone may be able to assist me.  I have a client who
is PEG fed and is NBM due to severe dysphagia.  She has had her PEG
since approx. 1999.  It has been raised by staff that she often gets a
very dry mouth (and throat).
 
I know that research has suggested ice chips in the past, do you know if
this is still considered a 'safe' thing to do considering she has severe
dysphagia .  Could someone provide any other suggestions.  I have tried
wetting lips, however staff report that this doesn't satisfy the 'dry'
throat (obviously).
 
Any suggestions would be appreciated.
 
Trish
 

Tricia Clark

Speech Pathologist

Cootharinga Society of North Queensland

Ph: 07 4759 2018

Fax: 07 4779 9443
Email: Tricia.Clark@cootharinga.org.au
Web: www.cootharinga.org.au <http://www.cootharinga.org.au/> 

<blocked::http://www.cootharinga.org.au/> 

================================================== 

NOTE:
 
This e-mail may contain privileged and/or confidential information,
which is the copyright of the Cootharinga Society of North Queensland
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should permanently delete this message and its attachments immediately
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number provided above. Any content of this message and its attachments
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Society of North Queensland must be taken not to have been sent or
endorsed by the Cootharinga Society of North Queensland. No warranty is
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------------------------------

Message: 2
Date: Mon, 13 Jun 2005 08:56:41 +0800
From: "Chris and Claire Langdon" <chris_claire@bigpond.com>
Subject: Re: [Dysphagia] Thickened liquids
To: <spunkles@hotmail.com>
Cc: Dysphagia@b9.com
Message-ID: <001901c56fb2$c31fcc30$a6e58a90@home>
Content-Type: text/plain;	charset="utf-8"

Hi Valerie

You may be interested in a website
http://www.kon.org/urc/biggs_cooper.html 
Abstract :The purpose of this study was to compare the physical
properties of nectar and honey-thickened juices, which are often
clinically recommended in dysphagia diets. The viscosity (thickness) of
four brands of powdered thickeners mixed with apple and orange juice was
measured at two and 10-minute intervals. Results indicated that: (a)
viscosity varied across powdered thickeners, (b) orange juice was
typically more viscous than apple juice, and (c) honey thick
consistencies became more viscous when allowed to thicken for a longer
time period for three of four thickeners. The results are discussed in
terms of their clinical implications for people with disordered
swallowing (dysphagia). 
and also

Cichero JA, Jackson O, Halley PJ, Murdoch BE. Which one of these is not
like the others? An inter-hospital study of the viscosity of thickened
fluids.J Speech Lang Hear Res. 2000 Apr;43(2):537-47. 
Abstract: This investigation examined the rheological (viscosity and
yield stress) and material property (density) characteristics of the
thickened meal-time and videofluorscopy fluids provided by 10 major
metropolitan hospitals. Differences in the thickness of thickened fluids
were considered as a source of variability and potential hazard for
inter-hospital transfers of dysphagic patients. The results indicated
considerable differences in the viscosity, density, and yield stress of
both meal-time and videofluoroscopy fluids. In theory, the results
suggest that dysphagic patients transferred between hospitals could be
placed on inappropriate levels of fluid thickness because of inherent
differences in the rheology and material property characteristics of the
fluids provided by different hospitals. Slowed improvement or medical
complications are potential worst-case scenarios for dysphagic patients
if the difference between the thick fluids offered by 2 hospitals are
extreme!
 . The investigation outlines the most appropriate way to assess the
rheological and material property characteristics of thickened fluids.
In addition, it suggests a plan of quality improvement to reduce the
variability of the thickness of fluids offered at different hospitals.


There's also an article that discusses the prevalence of thickened fluid
use in US skilled nursing facilities
Castellanos, V.H., et al., Use of thickened liquids in skilled nursing
facilities. J Am Diet Assoc, 2004. 104(8): p. 1222-6.
OBJECTIVE: Long-term care residents are routinely provided with
thickened liquids for the management of dysphagia. The objective of this
study was to identify the prevalence of thickened liquid use in skilled
nursing facilities. DESIGN: Facility-wide data were provided by staff at
252 randomly selected skilled nursing facilities owned by 11
multifacility providers. The sample represented 25,470 residents and
approximately 20% of all freestanding skilled nursing facilities
nationwide. MAIN OUTCOMES MEASURES: Data regarding prevalence of
thickened liquid use and facility characteristics were collected during
May 2002.Statistical analysis Descriptive statistics included national
and regional averages and national percentile distributions. RESULTS: A
mean of 8.3% (range 0% to 28%) of residents were receiving thickened
liquids, with considerable variation between Centers for Medicare and
Medicaid Services regions. Of those receiving thickened liquids, on
average 60% received "nec!
 tar/syrup" thick, 33% received "honey" thick, and 6% received
"pudding/spoon" thick, although the frequencies with which each
thickness was prescribed varied widely between facilities (range 0% to
100%). Thickened water was provided to residents in 91.6% of facilities.
Nationally, registered dietitian staffing levels were lower on average
than speech language pathologist staffing levels. CONCLUSIONS: Thickened
liquids are provided to a significant segment of the skilled nursing
facility resident population. In the absence of outcomes-based practice
standards to guide administrative decisions related to the provision of
thickened liquids, dietetics professionals may find regional and
national norms helpful for quality assurance processes and to inform
resource management decisions in clinical staffing and foodservice.
Finally, there's the problem of the difference between Newtonian and
non-Newtonian fluids in relation to thickeners - not all liquids behave
the same.  See
http://www.coleparmer.com/techinfo/techinfo.asp?htmlfile=HVFlow_WP.htm.
Anecdotally, there's been differences found in fluid thickness for fruit
juices - the same recipe, careful measuring, same brand of juice -
turned out to be based on seasonal variations in the sort of oranges
used by the juice manufacturer!

Best regards

Claire

----- Original Message ----- 
From: <sorriso@adelphia.net>
To: <spunkles@hotmail.com>
Cc: <Dysphagia@b9.com>
Sent: Sunday, June 12, 2005 8:05 PM
Subject: Re: [Dysphagia] Thickened liquids


> Good luck with this Valerie!  The subject has been discussed before
(search for it in the archives) and I believe  the upshot was that there
is no way to quantify thickness in our real life settings.
> 
> I'd like to suggest that any thickened liquid may be too thick.  Have
you screened/evaluated these folks lately to see if they can tolerate
thin liquids?  
> 
> Our rehab company picked up a new building two years ago in which
approximately 10 of the patients were on thickened (from nectar to spoon
thick) and none had been re-evaled.  I picked them up, a couple at a
time, and every single one of these people were able to go to thin and
remain on thin with no dire consequences.  
> 
> They fell into two groups:  some had been downgraded when ill and
never re-evaled when they got better or admitted long-term care from the
hospital, never identified and continued on thickened when they got
better.  People do get better!
> 
> Linda A. Zanchi, MA, CCC-SLP
> 
> 
> ---- Valerie Hartleb <spunkles@hotmail.com> wrote: 
> > Please help me!  I work in a nursing home and I have battling the 
> > administration re: how thick liquids should be when people are on
nectar and 
> > honey.  I believe the nursing home is overthickening resident's
liquids in 
> > return causing resident's not wanting to drink.  Please provide a 
> > explanation re: how thick liquids really should be.  I would value
anyone's 
> > opinion on this matter.  Thank you very much and I look forward to
hearing 
> > from you.
> > 
> > Thank you,
> > Valerie--Kalamazoo, MI
> > 
> > 
> > _______________________________________________
> > Dysphagia mailing list
> > Dysphagia@b9.com
> > http://lists.b9.com/mailman/listinfo/dysphagia
> 
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia

------------------------------

Message: 3
Date: Mon, 13 Jun 2005 08:34:56 -0500
From: "Hummelbrunner, Jackie" <JHummelbrunner@lwdh.on.ca>
Subject: RE: [Dysphagia] Dry mouth
To: "'Tricia Clark'" <Tricia.Clark@cootharinga.org.au>,
	dysphagia@b9.com
Message-ID:
	
<D0F05D837B4F6C4180887DC677DD821B144323@lws20015.hospital.lwdh.net>
Content-Type: text/plain

Oral Hygiene is crucial especially with a patient who is not eating
orally.
If you are able to achieve good oral hygiene this would make ice chips
less
risky as hopefully the oral bacteria would be lower and less dangerous
to
the resp health of the patient if aspirated.  Good oral hygiene must
have
mechanical teeth cleaning as well as fluoride and antibacterial
treatment as
well.  Improving the oral hygiene can help to improve xerostomia (dry
mouth).  Also check the meds to see if there are major contributors to
the
dry mouth.  Maybe something can be changed there.

Cheers,
Jackie Hummelbrunner

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf
Of Tricia Clark
Sent: Friday, June 10, 2005 12:05 AM
To: dysphagia@b9.com
Subject: [Dysphagia] Dry mouth

Hello everyone
 
Just wondering if someone may be able to assist me.  I have a client who
is PEG fed and is NBM due to severe dysphagia.  She has had her PEG
since approx. 1999.  It has been raised by staff that she often gets a
very dry mouth (and throat).
 
I know that research has suggested ice chips in the past, do you know if
this is still considered a 'safe' thing to do considering she has severe
dysphagia .  Could someone provide any other suggestions.  I have tried
wetting lips, however staff report that this doesn't satisfy the 'dry'
throat (obviously).
 
Any suggestions would be appreciated.
 
Trish
 

Tricia Clark

Speech Pathologist

Cootharinga Society of North Queensland

Ph: 07 4759 2018

Fax: 07 4779 9443
Email: Tricia.Clark@cootharinga.org.au
Web: www.cootharinga.org.au <http://www.cootharinga.org.au/> 

<blocked::http://www.cootharinga.org.au/> 

================================================== 

NOTE:
 
This e-mail may contain privileged and/or confidential information,
which is the copyright of the Cootharinga Society of North Queensland
and is intended only for the use of the addressee. If you received this
e-mail in error or you are not the addressee, or the person responsible
for delivering it to the person addressed, you may not use, copy,
disseminate, forward, print or deliver this to anyone else. Rather, you
should permanently delete this message and its attachments immediately
and kindly notify the sender by reply email or by telephone to the
number provided above. Any content of this message and its attachments
which does not relate to the official business of the Cootharinga
Society of North Queensland must be taken not to have been sent or
endorsed by the Cootharinga Society of North Queensland. No warranty is
made that the e-mail and/or attachment(s) are free from computer virus
or other defect. Thank you.

==================================================

 
 
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia


------------------------------

Message: 4
Date: Mon, 13 Jun 2005 09:00:27 -0500
From: "Christopher Babashka" <Christopher.Babashka@stalexius.net>
Subject: [Dysphagia] CVA Research
To: <dysphagia@b9.com>
Message-ID: <s2ad4b45.031@bordermanager.stalexius.net>
Content-Type: text/plain; charset=US-ASCII

Good Morning,
During a discussion with one of our neurologist he said "The leading
cause of death once a patient gets to the hospital after an acute CVA is
aspiration pneumonia" and that "Early administration of PO aspirin in
acute CVA does not have any effect on long-term outcomes, so they can be
STRICT npo until speech sees them!!!!!!!!"

I have searched and asked the neurologist for sources.  Does anyone
have any references that may prove or disprove these statements?

Thank you in advance,
Chris Babashka



------------------------------

Message: 5
Date: Mon, 13 Jun 2005 09:37:55 -0700 (PDT)
From: christabel daley <dysphagia@sbcglobal.net>
Subject: [Dysphagia] lingual frenum
To: dysphagia@b9.com
Message-ID: <20050613163755.83326.qmail@web81701.mail.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1

I have a 5yo nephew whose dentist recently rec lingual frenum sx.
History is insignificant for any speech, feeding, or swallowing issues.
I can't think of a reason to proceed with sx.  Does anyone have any
insight?  Is this type of procedure currently commonly being rec?  I
thought some years ago they had stopped doing these?


------------------------------

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End of Dysphagia Digest, Vol 19, Issue 7
****************************************