Japanese Clinical Practice Guidelines for Aspiration and Pharyngeal Residual Assessment During Eating and Swallowing for Nursing Care

Japan Journal of Nursing Science

Sugama, J., Ishibasi, M., et al. (2022).

Japan Journal of Nursing Science, 19(4), e12496.

This clinical practice guideline provides recommendations for the assessment of aspiration and pharyngeal residue, and provides recommendations for nursing care strategies for the prevention of aspiration pneumonia. The intended audience of this guideline is nurses working with people with dysphagia, however recommendations within the SLP scope are included within this summary.

Japan Academy of Nursing Science

"We propose to conduct an assessment of aspiration through a systematic assessment using physical assessment techniques (i.e., interview, visual examination, auscultation, and palpation) for individuals aged 18 years and older who are suspected of having a dysphagia...Caution: If the observation items are required for individuals with dysphagia to understand the evaluator's instructions, such as command swallowing of water, care should be taken when applied to individuals with impaired consciousness or severe cognitive impairment" (p. 10; Grade 2C Evidence).

"Providing management for oropharyngeal dysphagia based on a systematic assessment has been proposed using physical assessment techniques (interview, visual examination, auscultation, and palpation) for individuals aged 18 years and older with suspected dysphagia... Caution: Subsequent screening and diagnostic tests, including RSST [repetitive saliva swallow test], MWST [modified water swallowing test] , FT [food test], cervical auscultation, VFSS [videofluoroscopic swallow study], and FEES [flexible endoscopic evaluation of swallowing] based on systematic assessment using physical assessment techniques (i.e., interview, visual examination, auscultation, and palpation), are necessary for the implementation of appropriate care after physical assessment" (p. 12; Grade 2C Evidence).

" Individuals aged 18 years and older who are suspected of having dysphagia are suggested to be screened for aspiration using the RSST [Repetitive Saliva Swallowing Test]" (p. 12; Grade 2C Evidence).

"Screening for aspiration with the MWST [modified water swallowing test] for individuals aged 18 years and older who are suspected of having dysphagia has been suggested" (p. 13; Grade 2C Evidence).

"Individuals 18 years of age or older with suspected dysphagia are suggested to be screened for aspiration using a FT [food test]" (p. 14; Grade 2C Evidence).

"Individuals 18 years of age or older with suspected dysphagia are suggested to be screened for aspiration using cervical auscultation" (p. 15; Grade 2C Evidence).

"We propose that individuals aged 18 years or older who are suspected of having a dysphagia receive screening for aspiration and pharyngeal residues by observation with an ultrasound diagnostic device. We propose that nurses who have been certified by their instructors as being at a level where they can practice aspiration and pharyngeal residual observation techniques using ultrasound diagnostic device perform a screening by ultrasonography in facilities and home visit nursing agency that are equipped with ultrasound diagnostic device" (p. 17; Grade 2C Evidence).

"We propose that individuals aged 18 years or older who are suspected of having dysphagia should receive training in aspiration and pharyngeal residual observation using ultrasound diagnostic device and that nurses who have been certified by their instructors as having a practicable level of aspiration and pharyngeal residual observation skills using ultrasound diagnostic device should manage oropharyngeal dysphagia based on the results of observation using ultrasound diagnostic device in facilities and offices that are equipped with ultrasound diagnostic device. In facilities and offices that are equipped with ultrasound diagnostic device, management of oropharyngeal dysphagia is proposed to be based on the results of observations using ultrasound diagnostic device... Caution: Regarding the condition of the device to be used, a linear probe must be connected. The probe should have a bandwidth in the frequency range of 5–15 MHz. The resolution of the instrument should be set at a level that can clearly delineate the contours of the thyroid cartilage and epiglottis" (p. 18; Grade 2C Evidence). OF NOTE: This guideline was produced in Japan, in which physicians practice dysphagia evaluation and nurses may be trained to practice dysphagia screening, evaluation, and management protocols. Within the United States, dysphagia evaluation is typically performed by speech-language pathologists.