Authors (including presenting author) :
S Chan(1), H Chow(1), Kun Y W(2), Chan S S(2), Cheung L K(2), On Y M(2), Dr M Cheng(3), Dr TH Lee(3)
Affiliation :
(1)Department of Speech Therapy, (2)Department of Nursing, (3)Department of Rehabilitation
Introduction :
In our previous daily practice, the Ryles tube(R/T) is removed before the Flexible Endoscopic Examination of Swallowing (FEES) procedure to provide a better view. However, this arrangement has its drawbacks.
For cases where the test fails, the Ryles tube must be reinserted after the procedure, which is invasive, uncomfortable, potentially traumatic, risky and requires additional healthcare resources, both in terms of manpower and instruments.
For cases where the test is passed, the ward has to arrange the appropriate diet for our speech therapist (ST) for the mealtime oral trial. With the R/T removed, there is time pressure for the new food order, and the ST schedule may be disrupted by this ad hoc event.
If the R/T is not removed, it will eliminate the need for reinsertion for those who still require non-oral feeding after the examination. For those who pass the FEES exam, the clients can continue R/T feeding first, allowing time for food ordering and also making the ST manpower resources more flexible.
This arrangement is particularly important for cases requiring OGD-guided R/T insertion, as it not only needs to be done in the endoscopy centre but also involves inter-hospital transfer.
Objectives :
Nursing procedures for R/T removal and reinsertion can be saved
Related material fee could be saved
Patients avoid one invasive procedure, if necessary
Post-procedure, ST can have better arrangement for the weaning without ward schedule interruptions
Methodology :
Literature1-3 reviews indicate that FEES can be performed with the R/T in situ, as it does not affect the view or the swallowing mechanism.
Balancing the risks and the latest evidence, we have adopted a revised approach. For clients with a R/T in place before the procedure, the R/T will be left in situ and will only be removed if deemed necessary in the endoscopy room.
3month trial period in Sept-Nov 2024
Result & Outcome :
23 cases underwent FEES
9 cases (39%) were not on R/T
14 cases (61%) were on R/T
1 case required R/T removal during the procedure due to limited view from retained secretions
Implications
Based on the above finding, it is estimated that 92 cases undergo FEES annually (23cases/quarter x 4). Approximatelly 56 cases are on R/T. With implementation of this arrangement, it is estimated that at least 50 cases per year could be benefit from the above arrangement.
Conclusion
FEES procedure can be performed with Ryle’s tube in place. Patients, the health care team and the medical resources can all be benefit from this approach.
