A tracheostomy involves creating a surgical opening in the neck and inserting a tube into the windpipe (trachea) to facilitate breathing. This procedure provides an alternative airway, bypassing the nose and mouth. Whether individuals with a tracheostomy can safely drink water is complex and depends on their unique medical condition and swallowing ability.
How a Tracheostomy Affects Swallowing
Normal swallowing involves a coordinated process where the voice box (larynx) elevates, and a flap called the epiglottis closes over the windpipe, protecting the airway from food or liquid. The presence of a tracheostomy tube can interfere with this protective mechanism. The tube may physically restrict the upward movement of the larynx, which is necessary for proper airway closure during swallowing.
Additionally, the tracheostomy tube can reduce the sensation in the throat. This decreased sensation means an individual might not effectively detect if food or liquid has entered the airway. The tube can also affect the coordination between breathing and swallowing, further increasing the risk of material entering the lungs.
Risks of Aspiration
A primary risk for individuals with a tracheostomy is aspiration. Aspiration occurs when food, liquid, or saliva enters the airway and travels below the vocal cords into the lungs, rather than going down the esophagus to the stomach. Even small amounts of aspirated material can be dangerous.
Short-term complications of aspiration can include coughing, choking, and respiratory distress. Over time, repeated or significant aspiration can lead to serious issues such as pneumonia, lung infections, and long-term lung damage. Many tracheostomy patients may experience silent aspiration, where material enters the airway without obvious signs like coughing or choking, which is concerning.
Assessing Swallowing Safety
Determining an individual’s ability to safely drink with a tracheostomy requires a comprehensive evaluation. A Speech-Language Pathologist (SLP) typically conducts these assessments to evaluate swallowing. Initial evaluations may involve bedside swallow assessments, where the SLP observes the patient’s response to small amounts of water or thickened liquids.
More detailed instrumental assessments provide a clearer picture of swallowing mechanics. A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) involves inserting a thin, flexible scope through the nose to visualize the throat and vocal cords during swallowing. Another common assessment is the Modified Barium Swallow (MBS) study, which uses X-ray imaging to track the path of barium-coated liquids and foods as they are swallowed. These evaluations help identify the presence and severity of aspiration, guiding recommendations for safe oral intake.
Hydration Without Oral Intake
For individuals who cannot safely take fluids by mouth due to aspiration risk, alternative hydration methods are available. Intravenous (IV) fluids deliver liquids directly into a vein. This method is often used for short-term hydration or when oral intake is restricted.
Another common method involves tube feeding, where a thin tube delivers fluids and nutrients directly to the stomach or small intestine. A nasogastric (NG) tube is inserted through the nose, down the esophagus, and into the stomach. A gastrostomy (G) tube is surgically placed directly into the stomach through the abdominal wall. These methods ensure proper hydration and nutrition when oral swallowing is unsafe.