July 20, 2004 Feature

Syringe Feeding in Long-Term Care

Questions persist about syringe feeding for long-term nursing home and skilled care residents, particularly those with dementia. It appears some facilities dictate that speech-language pathologists must teach other involved professionals, including nurses, how to syringe feed the residents.

Syringe feeding is used to bypass the oral phase of the swallow when an oral phase problem is present. Syringes also are used to feed a resident quickly, introducing a fairly large bolus per swallow. This latter rationale, however, is totally inappropriate. Individuals unable to use a spoon due to reduced lip closure are certainly unable to use a syringe, which requires an adequate lip seal.

In my experience, syringe feeding is only appropriate for a patient with oral cancer who has undergone partial or total glossectomy. The individual self-feeds with the catheter and syringe, so that speed of feeding and amount per bolus are carefully controlled. Typically, a catheter is placed on the end of a syringe. The catheter can then be placed posteriorly in the oral cavity and liquids introduced. The catheter and syringe should only be used, however, when the individual demonstrates intact cognitive functioning. Further, the individual must demonstrate a functional pharyngeal stage of swallowing or the ability to use swallow maneuvers providing additional airway protection during the swallow. The catheter and syringe are soon replaced with cup drinking. Switching to the cup allows an increased intake per bolus swallow, as well as improving the patient's appearance. Again, the individual uses a cup independently, so that speed of feeding and amount perbolus are carefully controlled.

The catheter/syringe technique is also useful for patients who have their jaw wired shut and demonstrate intact pharyngeal phase swallowing.

I do not believe that syringe feeding is appropriate for patients who demonstrate severe oral problems, including severely impaired oral tongue function, swallow apraxia, and reduced oral sensation. It is also inappropriate for those who demonstrate overall reduced cognition, alertness, and awareness. These individuals may be at risk if material is placed in the mouth, since the oral deficits may be severe and material could spill over into the pharynx prematurely, causing aspiration before the swallow. Indeed, some individuals also may have pharyngeal stage swallowing disorders, and would be at risk for aspiration if material is syringed into the mouth, particularly if the individual demonstrates a pharyngeal swallow delay. Pharyngeal stage swallowing disorders should be identified before any food or liquid is introduced into the oral cavity.

A thorough literature review revealed only two articles that specifically refer to syringe feeding. In one article (Buckley, Addicks, & Maniglia, 1976), an example shows the technique used with a surgically resected patient with oral cancer, which is quite appropriate. The other article (Rogers & Snow, 1982), examined the feeding behaviors of the residents in skilled nursing facilities, with one of the objectives being to assess the adequacy of food intake. These authors found that if some residents self-fed too slowly, they were fed by nurses using syringes at some facilities. This study offered no other rationale for using the syringes other than increasing feeding "efficiency." Clearly, this is a poor reason for syringe use in feeding.

SLPs must have a rationale for using syringe feeding and must be aware of contraindications, particularly with specific patient populations and specific oropharyngeal swallowing disorders.

Cathy Lazarus, is associate professor in the department of otolaryngology, NYU School of Medicine, New York, NY. Her interests include evaluation and treatment of swallowing disorders. Contact her at cathy.lazarus@med.nyu.edu.

cite as: Lazarus, C. (2004, July 20). Syringe Feeding in Long-Term Care. The ASHA Leader.

Current State Regulations on Syringe Feeding

Ohio

OAC 3701-16-19 Community Alternative Homes

  • "No syringe feedings are permitted."

OAC 3701-17 Nursing Homes

  • "Shall not perform syringe feedings."

Maine

CMR 10-144-110 Regulations Governing the Licensing and Functioning of Skilled Nursing Facilities

  • "Syringe feeding may only be done after an evaluation by an appropriate professional and according to a plan of care developed by a multidisciplinary team."


References

Buckley, F. E., Addicks, C.L., & Maniglia, J. (1976). Feeding patients with dysphagia. Nursing Forum,15, 16–85.

Rogers, J. C. & Snow, T. (1982). An assessment of the feeding behaviors of the institutionalized elderly. The American Journal of Occupational Therapy, 36, 375–380.

Schwab, L. (1995). Hazards of using a syringe to administer medications. American Family Physician, 51, 1821.

Soriano, R. (1994). Syringe feeding: Current clinical practice and recommendations. Geriatric Nursing,15, 85–87.

Yen, P. H. (1991). When swallowing is a problem. Geriatric Nursing,12, 313.



  

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