Trach and eating

[ccjjcc]

Hi, I was going to ask a question about eating on a vent. My brother got his trach almost 3 months ago and the feeding tube with it. He has been tested several times and been given the go ahead to have liquids, and a mechanical soft diet.

He's had breakfasts for about a week.

Now, he is refusing the breakfasts (he doesn't like their eggs) and feeding tube altogether (4th day with no food of any kind, because he had an upset stomach Saturday) and wants "real" food, more substantial than mechanical soft diet he has been getting. (like steak, burgers, etc).

Where it gets complicated is this: he is in a nursing home. The speech person won't sign off for heavier food because it is too risky. I agree with her, because he only has 3 teeth and because when the CNA's fed him before the trach, he requested very LARGE bites, and he also insisted on eating while reclining at about a 45 degree angle, if that.
He almost choked at the nursing home in Chicago (before the trach) because the CNA's were in a hurry when they fed him, and because he only has 3 teeth, it takes him looong time to chew, and they get impatient, and try to shove another bite in. That was in Chicago. But I know CNA's are busy, and they are in a hurry. The way he almost choked in Chicago was he swallowed a bite of meat too soon because they were going to leave the room rather than wait. I think it is a recipe for disaster.

She had it set up where they had to get him up and take him somewhere to eat, and only a restorative aid could feed him, because they would do it right and make sure the right precautions were in place. There's no way they'll get him up for 3 meals, or that there will be an RA available for all 3 meals, which means it will be the CNA's feeding him. They're going to let him sign a "waiver" so it isn't their fault if he chokes.

I'm concerned if he tries that with the trach , it will have bad consequences. You would think you could train the CNA staff not to give in to him with the large bites and letting him not be sitting up enough, but he has a way of forcing them to do what he wants, even if it isn't safe. I'm concerned he'll choke.

 

[ccjjcc]

Also, I had read this on an old thread, and this is what the speech person where he is had also said - almost verbatim

Hi Everyone. Just wanted to make a few comments about eating and trachs. I am an licensed Speech Pathologist that works with trach/vent patients everyday at the hospital I work in. I would highly encourage anyone who has had a trach put in, to have a swallowing test done first before trying to eat. Trachs (whether they are cuffed, balloon inside that is inflated, or not) can hinder the larynx (voice box) from moving up and forward, which is needed to protect the airway when you swallow. Yes, many people can eat just fine with a trach and yes if you could eat fine before a trach, chances are you are more likely to be able to eat with it......but not always.

Having a trach also does not allow for airflow to get up to your vocal cords and upper airway, which is important for "feeling" if something has gone down the wrong pipe. This airflow provides more sensation to alert the body to cough. Trach patients I see for swallowing studies are commonly "silent aspirators" which means food/liquids gets into their airway and they do not respond with a cough or throat clear.
Again, trachs can alter the normal mechanics for swallowing, but do not always. I say rather be safe than sorry.

Hope this sheds a little light. There is so much info I did not get into, but would be happy to answer any more questions.

 

[sjhon]

If the patient eats by mouth, it is recommended that the tracheotomy tube be suctioned prior to eating after meals which may stimulate excessive coughing and could result in vomiting. That is very considerable matter.