The patient should be evaluated for aspiration risk and to document dysphagia.
(1) Oral intake should be used for a person willing to eat and with no risk for aspiration.
(2) Oral intake can be used in a person at low risk for aspiration provided intake complies with the recommendations of nutritional or rehabilitation consultants familiar with aspiration.
Criteria for considering enteral tube feeding:
(1) functional gastrointestinal tract distal to the esophagus
(2) either unwilling to eat or unable to have oral intake due to high risk of aspiration
(3) consent of the patient or decision-making surrogate
If the patient or surrogate decision maker do not want enteral tube feeding, then the final choice of nutritional support should comply with his or her wishes.
If the patient is a candidate for enteral tube feeding, then the route depends on the expected duration.
(1) If nutritional support will be needed short-term (less than 4 to 6 weeks) then placement of a nasoenteric tube should be considered.
(2) If nutritional support will be needed long-term (more than 4 to 6 weeks) then placement of a percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) tube should be considered.
The patient should undergo periodic evaluation of swallowing ability and risk of aspiration. A patient on oral diet may need to have an enteral tube placed, or an enteral tube may no longer be necessary.
