[DYSPHAGIA] Managing secretions/phlegm

[voice123@hotmail.com (Leslie Bilosz)]

Hello there:

Sounds if there could be a couple of possibilities with your case: 1. Are 
you noticing these difficulties around the time of tube feeds?  Are the 
feeds continuous or intermittent?  Some reflux issues with question of 
subsequent aspiration vs. other should be ruled out first with reflux 
precautions always in place (i.e. head of bed up always up, even when you 
are not there?).  Also, never enough oral care because of gram neg. bacteria 
risks in our facilities (pneumonia factor) and the tendency for staff to 
forego care because "the patient isn't eating" 2. Is there a question of 
poor secretion management due to decreased or absent reflexive swallows 
throughout the day?  I'm thinking also about the viscosity of the 
secretions.  Are they thick/stringy or thin?

I have found that when the aforementioned areas are addressed, and 
secretions are on the more viscous side, requesting M.D. input for 
consideration of a secretion thinner sometimes is of great help.  There has 
been some confusion on which way to go between nursing and medical on 
"drying up secretions" which may exacerbate both secretion viscosity and 
airway compromise (if aspiration is at all a concern), vs. thinners (or 
mucolytics) that can conversely decrease the above by breaking down 
molecules in the mucus.  I would love to hear more about your case (dx, cog. 
factors, and all).  Sometimes medical input can be a good thing while we are 
providing "other therapeutics," including practice of dry swallows.

Leslie W. Bilosz, M.S., CCC-SLP


>From: "Dolanjski, Carla" <Carla.Dolanjski@ACCAC.on.ca>
>To: "'dysphagia@medonline.com'" <dysphagia@medonline.com>
>Subject: [DYSPHAGIA] Managing secretions/phlegm
>Date: Fri, 2 Nov 2001 14:45:55 -0500
>
>I am wondering if anyone knows of an effective technique, other than
>suctioning to manage excessive phlegm in a patient that is completely NPO,
>gastrostomy tube-fed secondary to oral-pharyngeal resection.
>
>Carla Dolanjski
>Speech-Language Pathologist
>Algoma Community Care Access Centre
>(705)949-1650 Ext.237
>carla.dolanjski@accac.on.ca
>
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