Quiz 3- Week 9 Book/Article Cards Flashcards
(23 cards)
Procedures used to treat Dysphagia
Pharnygoesophageal Dilation Surgical Closure of the Larynx Standard Lineman Gastronomy Tube (GTs) Percutaneous endoscopic gastronomy (PEG) Tracheostomy Expiratory speaking valve Fenestrated Tracheostomy tube Decannulation Cricothyrotomy
What is Phyarnygesophageal Dilation?
- Oldest surgical procedure
- Uses tapered bougie tubes of increasing the diameter, inserted sequentially to expand stenotic segement or uses inflated balloons expanding the lumen
- Getting more popular due to its association with chemoradiation
What is surgical closure of the Larynx used for?
- Used when no other options available due to intractable aspiration
- Separates food from airway passage
- Provides pts. with option for continuing oral nutrition
- Commonly used with pts. with CVA and ALS
What is the Standard Lineman?
A procedure creates an anastomosis (a new connection made between two body structures that carry fluid, such as blood vessels or bowel) between the subglottic trachea and esophagus, and permanent stoma from distal trachea.
-Advantages: Simplistic, reliable and reversible
When is a GT used?
- Used with pts. who have exhausted all other efforts and have been unsuccessful or with pts. with severe nutritional deficiencies that cannot meet their caloric intake need by oral diet.
- It should be known that in pts. with diminished reflexes it may increase their risk of aspiration.
- May be beneficial for pts. with dysphagia (spec. stroke pts.) however, they may not help them.
- Not good for pts. with dementia
PEG
Percutaneous endoscopic gastronomy (PEG)
- Good temporary or permanent means for feeding
- Doesn’t necessarily prevent aspiration
Tracheotomy
-Doesn’t always help pts., sometimes can cause greater swallowing dysfunction and aspiration.
-Expiratory valves, fenestrated tubes, and cannulation are commonly used with trach patients to aid in swallowing.
Leder study, even with the small amt of participants suggests these devices build up pressure and does not always improve swallowing or reduce aspiration or penetration.
Tracheostomy tube
Tracheostomy tubes
- Tube placed into trachea through a transcervical incision.
- Often used with pts. who need prolonged ventilation.
- Provides airway and permits suctioning of aspiration secretions
- May result in greater dysfuntion and aspiration
Expiratory speaking valve
- Removable one-way valve that permits inhalation, closes during expiration and diverts airflow through the larynx.
- Advantages: Pts. can communicate verbally, airflow provides proprioceptive cues during swallowing exercises and. learning maneuvers, TVC adduction exercises minimized due to subglottic air pressure buildup, improved pressure to aid in bolus propulsion.
Fenestrated Tracheostomy tube
Opening which permits air to pass into upper airway and the oral cavity.
- Not suggested for long-term use.
- Causes granulation tissue, which is assoc. with bleeding and or life threatening airway compromise.
Decannulation
Most effective single intervention to enhance swallowing in pts. with a tracheostomy
-Whether or not pts. can handle this depends on estimated amt. of oral and trach secretions, and also by pts. tolerance to tube capping.
Cricothyrotomy
- Incision made through the skin and cricothyroid membrane to relieve respiratory obstruction.
- Used in lieu of a tracheotomy in emergency situations, and also electively in pts. undergoing surgery which requires a median sternotomy (aka. Cardiac bypass surgery)
Swallowing in regards to
Head and Neck cancer
- Recent studies show that swallowing rehab prior to surgery or chemoradiation can produce improvement in swallowing compared to pts. who are not treated prior to cancer txs.
- Kulbersh found that QOL was found to be significantly better in pts. who received swallowing rehab before their cancer therapy.
- Caroll study showed that pts. who received pretreatment exercises (ex. Mendahlson maneuver, tongue hold, effortful swallow, and shaker exercises resulted in significantly post treatment swallowing fxn. In pts with advanced head and neck cancer.
Late Outcomes
- Outcome related to extent of surgery and need for chemo and radiation, adequacy of and compliance of rehab plan.
- Usually the more extensive the surgery, the longer it will take to regain oral nutrition and more likely oral nutrition will the result in some swallowing difficulties.
What are the factors that interfere with QOL on the SWAL-QOL?
- Taking longer to eat than others
- Difficulty chewing
- Food sticking in the mouth
- Drooling
Dworkin study
pts. with advanced laryngeal cancer 1 year after tx with FEES and found that there was a degree of dysphagia regardless of the time frame.
- Long term outcomes were pts needed PEG feedings, texture modifications, slower eating times and an increased need to chew.
- Surgical or non surgical txs. have long term effects on swallowing fxn.
What is a Tracheostomy?
A tracheostomy is a surgically made hole that goes through the front of your neck into your trachea, or windpipe. A breathing tube, called a trach tube, is placed through the hole and directly into your windpipe to help you breathe
What is Tracheostomy used for?
A tracheostomy may be used to help people who need to be on ventilators for more than a couple of weeks or who have conditions that block the upper airways.
Where is a Tracheostomy completed and by whom?
- Surgeon in a hospital room under general anesthesia
- DR/ ER TECH by pts. bedside (Ex. ICU)
- Any life threatening situation
How long does a Tracheostomy procedure take?
20-45 min
What are cuffed tubes and when are they used?
Cuffed trach tubes may be used. These tubes use air to widen or narrow the tube to fit the hole. After inserting and placing the trach tube into the windpipe, the surgeon or other health care professional will use stitches, surgical tape, or a Velcro band to hold the tube in place.
How long does it take a pt. to recover from a Tracheostomy procedure?
- Up to two weeks for a trach tube to fully form, or mature. -You will not be able to eat normally and will likely receive nutrients through a feeding tube.
- Difficulty talking after is common.
- SLP can help you to regain normal swallowing & use your voice to speak clearly.
- Tube will be removed when no longer needed.
- Hole usually closes on its own, but surgery can close the hole if needed.
Common side effects after a
Tracheostomy procedure
-Bleeding, infection, pneumothorax/collapsed lung, or subcutaneous emphysema.
-Over time, complications may include:
windpipe scarring, fistula, food/saliva caught between the windpipe and esophagus that enter your lungs.
-It is also possible to have complications that affect the fxn of the trach tube (Ex. tube slipping/falling out of place, or windpipe or other airway structures are affected).
