Aspiration Precautions

Aspiration is the inhaling of a liquid or object into the lungs. Things that can be inhaled into the lungs include:

  • Food.

  • Any type of liquid, such as drinks or saliva.

  • Stomach contents, such as vomit or stomach acid.

When these things go into the lungs, damage can occur. Serious complications can then result, such as:

  • A lung infection (pneumonia).

  • A collection of pus in the lungs (lung abscess).

CAUSES

  • A decreased level of awareness (consciousness) due to:

  • Traumatic brain injury or head injury.

  • Stroke.

  • Neurological disease.

  • Seizures.

  • Decreased or absent gag reflex (inability to cough).

  • Medical conditions that affect swallowing.

  • Conditions that affect the food pipe (esophagus) such as a narrowing of the esophagus (esophageal stricture).

  • Gastroesophageal reflux (GERD). This is also known as acid reflux.

  • Any type of surgery where you are put under general anesthesia or have sedation.

  • Drinking large amounts of alcohol.

  • Taking medication that causes drowsiness, confusion, or weakness.

  • Aging.

  • Dental problems.

  • Having a feeding tube.

SYMPTOMS

When aspiration occurs, different signs and symptoms can occur, such as:

  • Coughing (if a person has a cough or gag reflex) after swallowing food or liquids.

  • Difficulty breathing. This can include things like:

  • Breathing rapidly.

  • Breathing very slowly.

  • Hearing "gurgling" lung sounds when a person breaths.

  • Coughing up phlegm (sputum) that is:

  • Yellow, tan, or green in color.

  • Has pieces of food in it.

  • Bad smelling.

  • A change in voice (hoarseness).

  • A change in skin color. The skin may turn a "bluish" type color because of a lack of oxygen (cyanosis).

  • Fever.

DIAGNOSIS

  • A chest X-ray may be performed. This takes a picture of your lungs. It can show changes in the lungs if aspiration has occurred.

  • A bronchoscopy may be performed. This is a surgical procedure in which a thin, flexible tube with a camera at the end is inserted into the nose or mouth. The tube is advanced to the lungs so your caregiver can view the lungs and obtain a culture, tissue sample, or remove an aspirated object.

  • A swallowing evaluation study may be performed to evaluate:

  • A person's risk of aspiration.

  • How difficult it is for a person to swallow.

  • What types of foods are safe for a person to eat.

PREVENTION

If you are a caregiver to someone who may aspirate, follow the directions below.

If you are caring for someone who can eat and drink through their mouth:

  • Have them sit in an upright position when eating food or drinking fluids, such as:

  • Sitting up in a chair.

  • If sitting in a chair is not possible, position the person in bed so they are upright.

  • Remind the person to eat slowly and chew well.

  • Do not distract the person. This is especially important for people with thinking or memory (cognitive) problems.

  • Check the person's mouth for leftover food after eating.

  • Keep the person sitting upright for 30 to 45 minutes after eating.

  • Do not serve food or drink for at least 2 hours before bedtime.

If you are caring for someone with a feeding tube and he or she cannot eat or drink through their mouth:

  • Keep the person in an upright position as much as possible.

  • Do not lay the person flat if they are getting continuous feedings. Turn the feeding pump off if you need to lay the person flat for any reason.

  • Check feeding tube residuals as directed by your caregiver. If a large amount of tube feedings are pulled back (aspirated) from the feeding tube, call your caregiver right away.

General guidelines to prevent aspiration include:

  • Feed small amounts of food. Do not force feed.

  • Use as little water as possible when brushing the person's teeth or cleaning his or her mouth.

  • Provide oral care before and after meals.

  • Never put food or fluids in the mouth of a person who is not fully alert.

  • Crush pills and put them in soft food such as pudding or ice cream. Some pills should not be crushed. Check with your caregiver before crushing any medication.

SEEK IMMEDIATE MEDICAL CARE IF:

  • The person has trouble breathing or starts to breathe rapidly.

  • The person is breathing very slowly or stops breathing.

  • The person coughs a lot after eating or drinking.

  • The person has a chronic cough.

  • The person coughs up thick, yellow, or tan sputum.

  • The person has a fever or persistent symptoms for more than 72 hours.

  • The person has a fever and their symptoms suddenly get worse.