Managing Aspiration Risks in Elderly Patients with Nasogastric Tubes

Q: Managing Aspiration Risks in Elderly Patients with Nasogastric Tubes

Hello Ir1350： When feeding Grandma, please pay attention to the following： 1. Elevate the head of the bed to 45 degrees or have her sit up. 2. Aspirate first to check if digestion is complete. 3. After feeding, flush the nasogastric tube with warm water. 4

Elderly patients with nasogastric tube insertion may experience aspiration issues?

Hello doctor, my grandmother has been experiencing difficulty breathing and low blood pressure, which led to her being admitted to the intensive care unit.
After about two days, she was transferred to a regular ward.
During her stay, she occasionally coughed up sputum that was mostly clear and white.
Initially, the plan was to observe and care for her for a few more days, but relatives decided to discharge her as soon as she seemed stable.
Now she is at home with a nasogastric tube for feeding.
My grandfather mentioned that she is also using supplemental oxygen, but I heard that she coughed last night.
With the oxygen, she can breathe better, but this situation is quite concerning.
Since she is currently using a nasogastric tube (which may be removed later), what should we do if she coughs due to sputum rather than choking on food? Is it necessary to readmit her if she chokes again shortly after being discharged? I would like to ask the doctor what steps we should take in this situation.
Thank you.

L, 20~29 year old female. Ask Date: 2023/02/26

Dr. Liang Yinpan reply Geriatrics

Hello Ir1350: When feeding Grandma, please pay attention to the following: 1.
Elevate the head of the bed to 45 degrees or have her sit up.
2.
Aspirate first to check if digestion is complete.
3.
After feeding, flush the nasogastric tube with warm water.
4.
If digestion is poor, provide smaller, more frequent meals.
For excessive phlegm, please note: 1.
Position her on her side or have her sit up and perform chest percussion every 2 hours.
2.
Encourage Grandma to cough up phlegm; any phlegm in her throat or mouth should be suctioned out.
3.
If she experiences choking on phlegm or food, leading to respiratory distress or persistent coughing, seek medical attention immediately.
Changhua Hospital, Geriatrics Department, Liang Yin-Pan, 2023-02-27.

Reply Date: 2023/02/26

More Info

Managing aspiration risks in elderly patients, particularly those with nasogastric (NG) tubes, is a critical concern in clinical practice. Your grandmother's situation highlights several important aspects of care for elderly patients who may be at risk of aspiration, especially after a recent hospitalization and with the use of an NG tube.

Understanding Aspiration Risks
Aspiration occurs when food, liquid, or other substances enter the airway and lungs instead of the esophagus. This can lead to aspiration pneumonia, a serious condition that can be particularly dangerous for elderly patients due to their often compromised immune systems and pre-existing health conditions. In your grandmother's case, her recent respiratory issues and the use of supplemental oxygen indicate that her respiratory status may still be fragile.

Factors Contributing to Aspiration
1. Neurological Status: Elderly patients may have diminished gag reflexes or impaired swallowing mechanisms due to age-related changes or neurological conditions, increasing the risk of aspiration.

2. Sedation and Medications: If your grandmother is on sedatives or medications that affect her level of consciousness, her ability to protect her airway may be further compromised.

3. Positioning: Proper positioning during feeding is crucial. Patients should ideally be in an upright position to minimize the risk of aspiration. If she is lying flat while being fed through the NG tube, this could increase the risk of aspiration.

Monitoring and Management
Given your grandmother's recent hospitalization and current use of an NG tube, here are some recommendations for managing her care:
1. Close Monitoring: Keep a close eye on her respiratory status. If she exhibits signs of distress, such as increased coughing, wheezing, or difficulty breathing, it may indicate aspiration or other respiratory complications.

2. Coughing and Clearing Secretions: Encourage her to cough and clear any secretions. If she is unable to do so effectively, suctioning may be necessary, which can be performed by healthcare professionals.

3. Hydration and Nutrition: Ensure she is receiving adequate hydration and nutrition through the NG tube. Dehydration can thicken secretions, making them harder to clear and increasing the risk of aspiration.

4. Educate Family Members: Make sure that family members understand the signs of aspiration and when to seek medical help. If she coughs persistently after eating or shows signs of respiratory distress, it may warrant a return to the hospital.

When to Seek Medical Attention
If your grandmother experiences significant coughing, difficulty breathing, or a sudden change in her condition, it is essential to seek medical attention immediately. Aspiration can lead to pneumonia, which may require antibiotics and further medical intervention.

Conclusion
In summary, managing aspiration risks in elderly patients with NG tubes requires vigilance and proactive care. It is crucial to monitor her closely for any signs of respiratory distress and to ensure she is positioned correctly during feeding. If there are any concerns about her condition, do not hesitate to contact her healthcare provider for guidance. Given her recent health issues, it is better to err on the side of caution and seek medical advice if you notice any concerning symptoms.

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