Modified Barium Swallow (archived topic)

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    CCCSLP
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    ZipZipperZippering
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    Modified barium swallow

    If an SLP insists on an MBS for a diet upgrade shouldn’t that same standard be applied for diet downgrade?

    Lisa Yauch-Cadden
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    RE: Modified barium swallow

    This is a really good question and my first response is: It depends. Often we downgrade for safety, based on overt s/s or risks seen at the bedside. I don’t think you need an MBS for this. In addition, if an MBS is not readily available, delaying a diet downgrade while waiting for an MBS could be dangerous for the patient. However, if the diet downgrade becomes a life sentence, or doesn’t solve the problem at the bedside, then I think an objective assessment would be helpful. I think we should always strive for the least restrictive diet and objective assessments play a role in this determination. What do you think?

    Marguerite Mullaney
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    RE: Modified barium swallow

    If the rationale is safety then how can you downgrade without fully investigating what is safe first? Too many times, we hear SLPs talk about a diet downgrade for safety sake but they base their recommendations on the same type of bedside exam that they will not trust for diet advancement. If a bedside is unreliable for advancement then it is unreliable for downgrade as well.

    Lisa Yauch-Cadden
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    RE: Modified barium swallow

    But do we have to fully investigate what is safe first? What if you can’t get an MBS for several weeks? What if there are overt s/s at the bedside on thin liquids, but not on nectar? Would you defer the liquid downgrade while waiting for the MBS, or would you downgrade based on clinical s/s and follow-up with the MBS as soon as possible?

    ZipZipperZippering
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    RE: Modified barium swallow

    What if there is silent aspiration on nectar? Couldn’t we be making the situation worse?

    Lisa Yauch-Cadden
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    RE: Modified barium swallow

    Perhaps. Perhaps not. The clinical eval is for making the best judgement you can given all of the information available to you. When the MBS (or FEES or FEESST) is readily available, great, use it. When it’s not, make on-going assessments at the bedside. Even with an instrumental eval, remember that it takes place in a contrived environment, reflecting brief moments in time. If the patient is not sufficiently challenged or the study ends due to an instance of aspiration or strategies are not assessed, the results may not be that helpful to the clinician at the bedside. Even if it is a thorough exam, the clinical assessment is still needed to put the instrumental results in context, in order to make the best recommendation for the patient. I think it is unwise to dismiss the bedside as unreliable, just as it is unwise to base all of your recommendations on an

    Lori Yauch
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    RE: Modified barium swallow

    Sorry I’m so tardy to the party but I’d like to comment. I believe as clienician’s our first responsibility is safety to the patient and minimizing the risk of aspiration. If clinical s/s of aspiration are noted and a thickened liquid or modified texture eliminates the signs such as cough, or pocketing we should proceed for the safety and comfort of the patient.. Initiate tx as appropriate and follow-up MBSS as is warranted /appropriate by clinical judgment and treatment protocol. Not all patients can wait for the MBSS to be scheduled and not all patients can participate in them.

     

    Lisa Yauch-Cadden
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    RE: Quote of the Week

    That’s ridiculous. Everybody knows that if you want to maintain aspiration, the head of th bed needs to be lower than 30

     


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