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[Dysphagia] VFSS
I'd be interested in knowing the reason. I've heard some truly absurd ones over yje years but since its use appears in several guidelines, particularly in the elderly and it is recognized by Medicare, I can only infer either ignorance or greed.
kathleen wright <hillivie423 at comcast.net> wrote: Our facility refuses to even discuss the use of clysis.
----- Original Message -----
From: "Irene Campbell-Taylor"
To:
Sent: Thursday, August 23, 2007 3:15 PM
Subject: [Dysphagia] VFSS
There seems to be a misunderstanding about VFSS and real meals. It's not
that it's only a moment in time, it's that in NO WAY does it reflect what
happens when a meal is being eaten. It doesn't matter how many trials you
have of how many consistencies, it will never show what happens in real
life. This has been shown repeatedly by Groher, Jones and Donner, Dua and
others and is what leads to false positives as well as false negatives. As
to what one does with the patient who coughs on thin liquids,. At the
risk of being repetitive, clysis is the usual answer to fluid maintenance in
the rest of the world: See:
Guidelines for the administration of subcutaneous fluids (hypodermoclysis)
to adult patients in the community (Please note: in the community)
http://www.leedspct.nhs.uk/archive/east/attachment/00000000abc3a292817efac1a68ba2a4/0000000077869cd00183e189f3a5caad/PL+010+SUBCUT+Fluids+Guideline.pdf_
_AND___
_____http://www.leedspct.nhs.uk/archive/northeast/attachment/00000000edcf3591017443e65dddbba8/000000006f897f618d249b47cf5e73f0/PL010+Sc+Guideline.pdf________________________________________________________
Age and Ageing 2005; 34: 215-217
Hypodermoclysis-a victim of historical prejudice
PRANOY BARUA, BIMAL K. BHOWMICK
Abstract
Hypodermoclysis (HDC) had fallen into disrepute after adverse clinical
incidents that were obviously the result of improper use of an ingenious
technique. HDC has clear advantages over alternative parenteral routes. It
has stood the rigor of scientific
scrutiny but failed to regain its past glory. This is possibly because of
our ignorance and inability to detach ourselves from an age-old prejudice.
This is an attempt to demystify some of the myths that surround it. The hope
is that older people are not denied an element of health care that they are
perhaps most well suited to.
_____AND one of the guidelines I cited yesterday:
GUIDELINE TITLE
Dehydration and fluid maintenance.
BIBLIOGRAPHIC SOURCE(S)
American Medical Directors Association (AMDA). Dehydration and fluid
maintenance. Columbia (MD): American Medical Directors Association (AMDA);
2001. 28 p. [15 references
GUIDELINE OBJECTIVE(S)
To improve the quality of care delivered to patients in long-term care
facilities
To guide the identification and management of dehydration and
fluid/electrolyte imbalance in older adults residing in the long-term care
settings
To present approaches that attempt to minimize the occurrence of
dehydration and fluid/electrolyte imbalance
Management of specific deficits and imbalances, as indicated, such as
fluid and electrolyte replacements or fluid restrictions. Fluid replacement
may be by various routes, including oral, hypodermoclysis, nasogastric or
gastrostomy tube or intravenous
AND re VFSS and meals:
Dua KS; Ren J; Bardan E; Xie P; Shaker R. Coordination of deglutitive
glottal function and pharyngeal bolus transit during normal
eating.Gastroenterology, 112:73-83 1997
AND
Groher M. The detection of aspiration. Dysphagia, 9; 147. 1994
Martin-Harris ; Logemann et al. The clinical utility of the modified
barium swallow. Dysphagia 15; 2000. 136.
JonesB, Donner M. Normal and abnormal swallowing, Springer 1999.
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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