Lippincott Williams & Wilkins

Eating with a Trach

Author(s): Betty Weber
Source: The American Journal of Nursing, Vol. 74, No. 8 (Aug., 1974), p. 1439
Published by: Lippincott Williams & Wilkins
Stable URL: http://www.jstor.org/stable/3423009
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 .........

Eating with aTrach

This author observed patients with tracheostomies
and discovered that head position affects swallowing.

BETTYWEBER

Over an 18-month period, I ob-

served 41 patients who required a
tracheostomy for respiratory failure.
Of these, 14 had little or no difficulty
in eating and drinking while on or
off a mechanical ventilator. However,
27 patients with cuffed tracheos-
tomy tubes could not swallow with-
out aspirating food and liquids.
Many tracheostomy patients have
a partial or complete loss of gag re-
flex due to age or neurologic deficit.
Therefore, food and liquids enter the
trachea when they try to swallow.
Difficulty is first noted when patients
are unable to manage their own se-
cretions adequately. If the cuff is
completely deflated, of course, these
patients aspirate fluids and require
immediate suctioning.
An inflated cuff may bulge posteri-
orly and, because the posterior tra-
cheal wall lacks cartilage, the cuff
compresses the esophagus and causes
regurgitation. Yet, the 27 patients I
observed who had difficulty swallow-
ing regurgitated whether or not the
cuff was fully or partially inflated.
These patients required a gastrosto-
my tube for nutrition. Because eat-
ing or drinking is, for many, their
only enjoyment, patients who are un- When the head is hyperextended (top), the esophagus narrows and food
able to swallow adequately are often and fluids can easily flow into the trachea. The esophagus opens wide
disappointed and discouraged and and the epiglottis closes completely when the head is anteflexed (bottom).
may withdraw completely.
I observed two patients who were It is very easy to aspirate when is flexed, chin down, the airway nar-
eating at the same time. One could the chin is elevated. Therefore, a pa- rows and the esophagus opens wide.
not swallow well; the other experi- tient who has difficulty swallowing When the head is erect or hyperex-
enced no difficulty. What was one should tilt his head forward to pre- tended, chin up, the airway is verti-
doing that the other was not? The vent aspiration. Similarly, a naso- cal and fully open.
person who had difficulty swallow- gastric tube can be passed more eas- Twelve patients with tracheosto-
ing held his head erect and slightly ily when the head is anteflexed, and mies were instructed to flex their
hyperextended; the one who swal- a tracheal suction catheter can be heads before swallowing solid food
lowed without any problems had his passed best when the patient's head or liquids. None experienced any dif-
head slightly anteflexed. is extended. ficulty. All such patients should be
MS. WEBER, a graduate of Sacred Heart Gen- Cinefluorograms document the told to flex their heads when they
eral Hospital School of Nursing, Eugene, Ore., anatomical changes associated with eat and drink. This should help to
is night duty relief nurse at the Veterans Ad-
ministration Hospital, Portland, Ore. these two positions. When the head reduce aspiration. A

VOLUME74, NUMBER 8 AUGUST 1974 1439

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