This document provides an overview of clinical analysis on fluid thickeners and their administration. It defines different types of fluid thickeners based on viscosity, including nectar thick, honey thick and pudding thick. Common thickeners include commercial and homemade options. Fluid thickeners are clinically indicated for dysphagia and used to reduce risks of aspiration, malnutrition and dehydration. The document outlines responsibilities of registered nurses in assessing residents, prescribing and administering thickeners appropriately.
3. Introduction
◦ At any times in care homes, there will be residents
with impaired ability to eat and drink safely.
◦ Dysphagia also put people at risk of malnutrition,
dehydration, aspiration pneumonia and chocking.
◦ Normal aging reduces muscle tone in pharynx and
oesophagus
◦ Residents with dementia may even forget some of
their daily living activities including chewing and
swallowing
4. Penny B (2014); Use of fluid thickener o reduce dysphagia risk; NursingTimesVol
110 No 12, 19-03-2014
Zuckerman D (2013);Thickeners and other ways to help older adults with
swallowing problems
Hines S et al (2010);Thickened fluids for people with dementia in residential aged
care facilities; School of Nursing,Queensland University ofTechnology, Australia
Cichero J (2013);Thickening agents used for dysphagia management; effect of
bioavailability of water, medication and feeling of satiety; School of pharmacy,
Queensland, Australia
5. Definition
Thickened fluids are formulations that have a thickener added to
make them thicker.
Thickener is a substance which can increase the viscosity of a
liquid without substantially changing its other properties.
The goal of using thickeners is to make all liquids, including
beverages into a thicker consistency that is less likely to cause
aspiration
6. Types
Mildly Thick Moderately Thick Extremely Thick
Nectar Thick
Can be drink out of a
cup
Honey Thick
Often consumed with
a spoon but still retain
its liquid texture
Pudding Thick
Extra thick and to be
eaten with spoon
30% to 60%* 18% to 33%* • 6% to 12%*
*Cichero J (2013); Thickening agent used for dysphagia management
7. FORMULATION
Most of the commercially available thickening powders
include directions for use for getting right consistency
General Guidelines
Nectar thick – 1.0 teaspoon powder to 0.5 cup of thin
liquid
Honey thick – 1.5 teaspoon powder to 0.5 cup of thin
liquid
Pudding thick- 2.0 teaspoon powder to 0.5 cup of thin
liquid
10. COMMON THICKENERS
Home made thickeners
Banana flakes, cooked cereals, cornstarch, custard mix, mashed
potatoes, pureed fruits & vegetables etc
Commercially available thickeners
Stir in Thickener Blended Thickener
Karicare
Quik Thik
RD Thickener
East Thick
Thick plus
Keltrol
Nutulis
Viscaid
11. Clinical Indications
Dyspagia
Dysphagia can occur due to
Old age & Dementia
Neurological conditions
Parkinson's disease, reflex disease, stroke, head or spinal
cord injury
Cancer of head, neck or oesophagus
12. (Actual name and identification details of residents are withheld to adhere to the
privacy policy)
Clinical Facility West Harbour Lodge
No of Residents 2
Assessed by RN with dietician / speech
therapist
Thickener Prescribed Nutilis
13. Result
Assessment Criteria Ms Alpha Ms Beta
Clinical Condition Chronic renal impairment,
Cognitive impairment
Advanced senile dimentia
Clinical History COPD, Type 2 Diabetics,
Left Hemiplegic,
Hypertension
Osteo arthritis, raynaud’s
disease, supra nuclear
palsy, anaemia, rheumatic
fever, scoliosis
Reason for administration
of thickened fluid
Palliative care Palliative care
Manifestations Dysphagia Chocking
Thickener used Nutilis Nutilis
Grade used Moderately thick Moderately thick
Reason for withdrawal Reassessment of
improvement in condition
Reassessment of
improvement in condition
15. RN Responsibility
RN in collaboration with dietician assess the resident for bed
side swallowing screen
Plan diet for resident with right consistency in accordance to the
findings of swallowing screen
Fluid thickeners are to be prescribed by GP or dietician
Document each administration including any specific changes or
preferences required by the resident or relatives.
Educate health care staffs, chefs and relatives of residents
regarding the importance of thickened fluid diets
16. RN Responsibility
Oceania Group Policy
The fluid consistency must be recorded on
PCCP eating and drinking section
Dietary requirement form
On any sight specific lists detailing beverages or food
requirements.
To be clearly stated on PCCP whether the thickened fluid is a short
term intervention or not, and if so the next date of review.