8th August 2024

Nutrition and hydration

Difficulty with nutrition and hydration may stem from reduced functional ability affecting cooking and feeding or due to impaired coordination of muscles used in swallowing.  Dysphagia affects up to 50% of people in the acute phase following a stroke. It is associated with significant morbidity, including from aspiration pneumonia, malnutrition and prolonged hospitalisation and as a consequence increased mortality.

All patients with suspected stroke should be assessed with a swallow screen within four hours. If swallowing is deemed to be impaired at this point or if concerns develop during the admission, involve SLT to assess the dysphagia and dieticians to advise on nutrition.

Interventions include:

• 1ˢᵗ line: nasogastric tube (NGT) insertion if swallow deemed to be unsafe >24 hours
• 2ⁿᵈ line: if persisting dysphagia >4 weeks (or in anticipation of dysphagia in some neurological conditions such as motor neurone disease), consider percutaneous endoscopic gastrostomy (PEG) insertion, which confers reduced risk of treatment failure compared to long-term NGT use. Main side effects of PEG insertion include aspiration and infection; pneumoperitoneum is a common, benign finding and, in the absence of peritonitis, should resolve spontaneously in days

Image Source: Wikimedia Commons (2014). Diagram showing the position of a nasogastric tube CRUK 340, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Diagram_showing_the_position_of_a_nasogastric_tube_CRUK_340.svg (Accessed: 17 January 2024)

Image Source: Wikimedia Commons (2014). Diagram showing the position of a percutaneous endoscopic gastrostomy (PEG) feeding tube CRUK 341, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Diagram_showing_the_position_of_a_percutaneous_endoscopic_gastrostomy_(PEG)_feeding_tube_CRUK_341.svg (Accessed: 17 January 2024)