Swallow Evaluation with Nasogastric Tube In Situ

Evidence Supporting Swallow Evaluation with NGT

The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends that swallow evaluations, including videofluoroscopic swallow studies (VFSS) and clinical bedside assessments, can and should be performed with a nasogastric tube in place, as the tube does not significantly impair swallowing function or prevent dysphagia therapy in adult patients, particularly stroke patients 1
Three recent studies, including two specifically in stroke patients, demonstrated that nasogastric tubes do not negatively impact swallowing function, according to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines 1
Dysphagia therapy should start as early as possible in both tube-fed and non-tube-fed patients—the presence of an NGT should not delay assessment or treatment, as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) 1

The American Heart Association recommends performing swallow screening, such as a bedside water swallow test, before allowing oral intake in all stroke patients, regardless of NGT presence, to identify high-risk patients 2, 3
A wet voice after swallowing, incomplete oral-labial closure, or high NIHSS score are independent predictors of aspiration risk that should prompt formal evaluation, according to the American Heart Association 2, 3

The American College of Chest Physicians recommends that videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) should be performed to identify appropriate treatment strategies, even with an NGT in place, in adult patients, particularly stroke patients 4
These instrumental evaluations are essential not just for diagnosis but to determine which therapeutic techniques will eliminate aspiration during oral eating and drinking, as recommended by the American College of Chest Physicians 4

The European Society for Clinical Nutrition and Metabolism (ESPEN) suggests using small diameter nasogastric tubes (8 French) in stroke patients to minimize the risk of internal pressure sores and reduce any potential mechanical interference 1
Proper tube securement is essential—40-80% of NGTs become dislodged without appropriate securement, which can lead to pharyngeal coiling and actual swallowing problems, according to the European Society for Clinical Nutrition and Metabolism (ESPEN) 1

The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends not removing the NGT before swallow evaluation unless pharyngeal coiling is suspected, in adult patients, particularly stroke patients 1
The American Heart Association recommends performing bedside swallow screening first (water swallow test) to identify high-risk patients, in adult patients, particularly stroke patients 2, 3
The European Society for Clinical Nutrition and Metabolism (ESPEN) and the American College of Chest Physicians recommend proceeding to instrumental evaluation (VFSS or FEES) if aspiration risk is identified, with the NGT remaining in place, in adult patients, particularly stroke patients 1, 4
The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends checking for pharyngeal tube coiling via endoscopy or repositioning the tube if dysphagia worsens unexpectedly, in adult patients, particularly stroke patients 1
The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends beginning dysphagia therapy immediately based on findings, without waiting for NGT removal, in adult patients, particularly stroke patients 1