FLUID THICKENERS

Clinical Analysis on Fluid Thickeners and its Administration

Aswathy GS NairCAP Student

Contents

Introduction Evidences Used Definition and Types Formulation Clinical Indication Analysis RN Responsibility Conclusion

Introduction◦ At any times in care homes, there will be

residents with impaired ability to eat and drink safely.

◦ Dysphagia also put people at risk of malnutrition, dehydration, aspiration pneumonia and chocking.

◦ Normal aging reduces muscle tone in pharynx and oesophagus

◦ Residents with dementia may even forget some of their daily living activities including chewing and swallowing

Evidences

Penny B (2014); Use of fluid thickener o reduce dysphagia risk; Nursing Times Vol 110 No 12, 19-03-2014

Zuckerman D (2013); Thickeners and other ways to help older adults with swallowing problems

Hines S et al (2010); Thickened fluids for people with dementia in residential aged care facilities; School of Nursing, Queensland University of Technology, Australia

Cichero J (2013); Thickening agents used for dysphagia management; effect of bioavailability of water, medication and feeling of satiety; School of pharmacy, Queensland, Australia

Definition

Thickened fluids are formulations that have a thickener added to

make them thicker.

Thickener is a substance which can increase the viscosity of a

liquid without substantially changing its other properties.

The goal of using thickeners is to make all liquids, including

beverages into a thicker consistency that is less likely to cause

aspiration

Types

Mildly Thick Moderately Thick Extremely Thick

Nectar Thick Can be drink out of a cup

Honey Thick Often consumed with a spoon but still retain its liquid texture

Pudding Thick Extra thick and to be eaten with spoon

30% to 60%* 18% to 33%* • 6% to 12%*

*Cichero J (2013); Thickening agent used for dysphagia management

FORMULATION Most of the commercially available thickening

powders include directions for use for getting right consistency

General Guidelines

Nectar thick – 1.0 teaspoon powder to 0.5 cup of thin liquid Honey thick – 1.5 teaspoon powder to 0.5 cup of thin liquid Pudding thick- 2.0 teaspoon powder to 0.5 cup of thin liquid

FORMULATION

*Adapted from Australian standardised definitions and terminology for texture-Modified foods and fluids, Nutrition & Dietetics 2007

COMMON THICKENERS Home made thickeners

Banana flakes, cooked cereals, cornstarch, custard mix, mashed potatoes, pureed fruits & vegetables etc

Commercially available thickeners

Stir in Thickener Blended Thickener

Karicare Quik Thik RD Thickener East Thick

Thick plus Keltrol Nutulis Viscaid

Clinical Indications Dyspagia Dysphagia can occur due to

Old age & Dementia Neurological conditions

Parkinson's disease, reflex disease, stroke, head or spinal cord injury

Cancer of head, neck or oesophagus

(Actual name and identification details of residents are withheld to adhere to the privacy policy)

Analysis

Clinical Facility West Harbour Lodge

No of Residents 2

Assessed by RN with dietician / speech therapist

Thickener Prescribed Nutilis

ResultAssessment Criteria Ms Alpha Ms Beta

Clinical Condition Chronic renal impairment, Cognitive impairment

Advanced senile dimentia

Clinical History COPD, Type 2 Diabetics, Left Hemiplegic, Hypertension

Osteo arthritis, raynaud’s disease, supra nuclear palsy, anaemia, rheumatic fever, scoliosis

Reason for administration of thickened fluid

Palliative care Palliative care

Manifestations Dysphagia Chocking

Thickener used Nutilis Nutilis

Grade used Moderately thick Moderately thick

Reason for withdrawal Reassessment of improvement in condition

Reassessment of improvement in condition

RN Responsibility

RN Responsibility

RN in collaboration with dietician assess the resident for bed

side swallowing screen

Plan diet for resident with right consistency in accordance to

the findings of swallowing screen

Fluid thickeners are to be prescribed by GP or dietician

Document each administration including any specific

changes or preferences required by the resident or relatives.

Educate health care staffs, chefs and relatives of residents

regarding the importance of thickened fluid diets

RN Responsibility

Oceania Group Policy The fluid consistency must be recorded on

PCCP eating and drinking section Dietary requirement form

On any sight specific lists detailing beverages or food requirements.

To be clearly stated on PCCP whether the thickened fluid is a short term intervention or not, and if so the next date of review.