Assessment

Dysphagia is typically diagnosed by a team.

 
 

For the diagnosis to be aspiration pneumonia, a doctor, pulmonologist or radiologist will make a diagnosis after looking at an x-ray and seeing liquid in the lungs, known as infiltrates. 

 
 SLPs work to treat the cause, not the symptom to ensure the pneumonia won't be recurring. 

SLPs work to treat the cause, not the symptom to ensure the pneumonia won't be recurring. 

Determining the cause of Aspiration Pneumonia

Medical charts don't always say what causes the aspiration pneumonia, but Speech-Language Pathologists (SLP) need to treat the cause, not the symptom, to ensure the pneumonia won't be recurring. Along with consulting your medical team, the following screenings and evaluations may be conducted by an SLP to determine the cause of the pneumonia. 

 Despite the name, a bedside evaluation does not always happen at the side of the bed. 

Despite the name, a bedside evaluation does not always happen at the side of the bed. 

Screening

A Yale 3-Ounce Water Screen, commonly referred to as a bedside evaluation, is screener typically administered by a SLP to assess whether further investigation into a swallow should be conducted. Although the name colloquially includes "bedside," the assessment does not have to happen at the side of the bed. These evaluations are conducted in doctors offices and clinics just as often as they are conducted beside the bed in hospitals or nursing facilities. The term "bedside" is used to differentiate this assessment from evaluations that use imaging (Groher 132). 

Additionally, an SLP may observe the patient eating or drinking or interview the patient, family, or caregivers to assess whether further evaluation is needed. 

For more info:

 
 
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Evaluation

FEES and MBSS are the gold standards for detecting aspiration. The right evaluation depends on what you need to know:

  • Fiberoptic Endoscopic Evaluation of Swallowing (FEES) - you can see before and after the swallow, but not during.

  • Modified Barium Swallow Study - you can see during the swallow.

Both are tools that can be used to help determine if aspiration is occurring and then know their risk for developing aspiration pneumonia.

Blue Dye Tests

Swallowing problems can also be caused by injury, disease and tracheostomy. Patients with tracheostomies are at increased risk of silent aspiration or aspiration pneumonia. Those with tracheostomy are at risk for aspiration if they have had trauma, severe pulmonary disease, advanced age, reduced muscle tissue, an altered mental state or as a side effect to some medications. If someone has a tracheostomy, SLPs will often use a blue dye test (or they will call it a green dye if green dye is used) to check for potential aspiration. Green and blue are used because these are colors not normally found in the body. You may want to ask someone to do a blue dye test if you think there may be a swallowing problem. Indicators are difficulty or refusal to eat, an overreaction or no reaction to food in the mouth, choking and/or coughing while eating or drinking, vomiting, evidence of food in tracheostomy secretions, excessive drooling, large amounts of watery secretions from trach, congested lung sounds or frequent respiratory infections. With the Evan’s Blue Dye Test, blue dye is placed on the tongue every four hours. For the Modified Evan’s Blue Dye Test, foods and liquids are stained with blue dye and given orally. A positive indicator of potential aspiration is blue dye in the trachea as the client’s tracheostomy is suctioned. Blue Dye tests are quick and inexpensive, non-invasive, don’t expose the patient to radiation, and can be used when patient is not stable enough for instrumental exam. However, there are also a large amounts of false negatives and they perform better with gross aspiration, not picking up on small amounts of aspiration.