[Dysphagia] Re: Clear fluids

[sharon.manders at gmail.com (Sharon Manders)]

Re: managing water - I agree. All of my patients are always tested
with water as much as possible, and they all eventually get it - to do
otherwise is cruel and inhumane as far as I am concerned. One of the
reasons I stopped ordering clear fluids is that to me, my patients can
either drink, or they can't. I think (but am not sure) our hospital's
clear fluid 'texture' is a holdover from other SLPs, and it confuses
the diet office and dietitians to no end.

I should clarify in case I misspoke, that the clear fluid 'texture' is
ordered in conjunction with a food texture. For example, a patient may
be ordered a minced diet, with thin, clear liquids, we (SLPs) never
just order a clear liquid diet. I only order liquid diets with some of
my patients with dementia whose only remaining ability to ingest
calories is by drinking. Even then, they get oatmeal or something
similar on their trays, just in case. I have had success though with
lots of cream soups, Ensure, milk, juice etc - and for all the RDs out
there - I never do anything without input from the 2 that I work with.

We do of course have the surgical clear fluid diet, but if the
surgeons have any question when they are starting a solid food diet,
we are referred for an assessment as soon as is appropriate for that
patient.

I also know that the main culprit is saliva and I spend endless hours
educating nurses, health care aids, patients, family, doctors, OTs,
PTs, RDs, SW and anyone else who will listen on the absolute necessity
of oral hygiene.

Do you happen to have any references about how much sugar/lactose is
harmful to people who aspirate (given all the caveats you have
mentioned in prior messages)?

Thanks for the input and I appreciate any and all feedback.

Thanks,

Sharon
-- 
"Death is caused by swallowing small amounts of saliva over a long
period of time."
 - George Carlin


On 10/3/06, Irene Campbell-Taylor <eripley@yahoo.com> wrote:
> Medically speaking, clear fluids are those that leave minimal residue in the
> GI tract.  That's why they're ordered before and after certain surgeries
> etc. There is, however, disagreement among anesthesiologists as to what,
> exactly, constitutes "clear liquids." A clear liquid diet is not adequate in
> calories and nutrients. It should not be used for more than five days unless
> high-protein gelatin or other low-residue supplements are added. A good rule
> of thumb for a clear liquid  is anything you can see through. For example,
> apple juice is a clear liquid; milk is not.
> One would have to aspirate an great deal of sugar/lactose containing
> material before it would make the slightest difference.  Again, one's own
> saliva is the greatest hazard.What's wrong with seeing how the patient
> manages with water?  If they can drink water, they can drink anything.
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com