Thickened liquids and straws?

Anueva · Jul 3, 2015

That's very strange considering the fact that patients/residents on a thickened diet are generally never allowed to use a straw to avoid choking. I would also think using a straw may be a bit more difficult due to the fact that it is a thickened liquid. I would like to know also for future references, so hopefully someone will have an answer.

MunoRN, RN · Jul 3, 2015

This has been an ongoing debate where I work and it would be nice to see a more evidenced based rationale than what is currently used.

For a long time I had assumed that patients with "no straws" orders had been evaluated on their swallowing with a straw and failed. Then I spoke with speech therapist who said that it's just a standard rule for anyone with dysphagia. We have some intensivists who have pointed out recent studies that show a large portion of patients with dysphagia actually do better with straws (supposedly because it encourages a more natural suckling technique). The ST response was that saying "no straws" is just how they've always done it based on the 'logic' that using a straw allows for faster liquid intake which increases aspiration risk, although they admit there was never any evidence to support this, it was always just antidotal. We've had patients with recurrent admissions for aspiration pneumonia who get their "no straws" orders continued by ST in the hospital and come right back to the ICU due to continued aspiration. The intensivist then overrides the ST order and orders "liquids by straw only" and the patient does fine, no more aspiration events. I'm sure there are those patient who shouldn't use straws, but I don't think this is something we have completely figured out.

K+MgSO4, BSN · Jul 3, 2015

It depends on if the person can perform the pursed lip suckling action and follow through swallow. Think about that amount of muscles required for that.

pixiestudent2 · Jul 3, 2015

I've never seen a no straw order. But patients generally prefer not to use them with thickened liquids, because it's difficult.

(I think it's actually goes in slower via a straw, that stuff is pretty thick...)

CelticGoddess, BSN, RN · Jul 3, 2015

The only patients have had with thickened liquids who could drink with a straw have passed a speech therapy eval using a straw. Some actually do better with a straw than without. I've also had patient who were on regular liquids who had a "drink with straw only" order. Speech will eval all with swallowing risks for the best way for them to drink/eat. This is at my current facility though. Other places I have worked, no straw

Lec107805 · Sep 9, 2016

Well, I understand this is over a year old, but I was looking up some stuff on the internet and came across this post and thought I'd add my 2 cents. There can be many reasons why thickened liquids would be recommended for a patient. Many times though a patient's swallow "trigger" can be delayed. Because thickened liquids move slower and are "heavier" than thin liquids, they might be recommended for someone with a delayed swallow respose. Straws can increase the rate of flow of liquids and make the liquids move "faster" than if taking a sip from a cup. So if you think about someone being on a thickened liquid to give them more time for a swallow response, then using a straw could be counterproductive as it can increase the rate of flow. But there should never be a blanket statement of "if you're on thickened liquids you can't have a straw" the patient should be assessed with cup and straw, and then should use whatever is deemed safest by ST. I have people on nectar thick liquids that do better with a straw, and then I have those who can't use a straw as it increases chance of penetration/aspiration.