Aspiration

Definition

Aspiration is the entry of oropharyngeal or gastric contents (food, liquid, saliva, emesis) into the airway below the vocal cords. It can cause pneumonitis, pneumonia, or airway obstruction.

Risk Factors

• Dysphagia (stroke, Parkinson's, dementia)
• Altered level of consciousness
• NG tube or tracheostomy
• Decreased cough and gag reflexes
• GERD
• Sedation and post-anesthesia recovery

Prevention

Elevate head of bed 30 to 45° during and 30 to 60 minutes after meals/tube feedings. Perform swallow screening before oral intake post-stroke. Use thickened liquids for dysphagia. Check NG tube placement and residuals per protocol. Suction secretions before repositioning and encourage chin-tuck swallowing.

Signs of Aspiration

Coughing or choking while eating, wet/gurgly voice, decreased SpO2, fever, tachypnea, and new adventitious breath sounds in the right lower lobe (most common site).

Nursing Interventions

Stop feeding immediately, position in high Fowler's, suction airway, administer oxygen, and notify the provider. Obtain chest x-ray; expect broad-spectrum antibiotics if pneumonia develops.

NCLEX Relevance

Major safety topic. Tube feeding questions almost always include HOB elevation.