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.

1. Clinical Analysis on Fluid Thickeners
and its Administration
Aswathy GS Nair
CAP Student

2. Contents
 Introduction
 Evidences Used
 Definition and Types
 Formulation
 Clinical Indication
 Analysis
 RN Responsibility
 Conclusion

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

8. FORMULATION
*Adapted from Australian standardised definitions and terminology for texture-
Modified foods and fluids, Nutrition & Dietetics 2007

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

14. RN Responsibility

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.