For a patient with a tracheostomy during swallowing therapy, which statement is correct?

• A. Have the patient sit in the bed at a 120-degree angle before occluding the tracheostomy.
• B. Cervical auscultation to determine aspiration.
• C. No need to occlude tracheostomy during and immediately after swallow; no chance of aspiration.
• D. Occlude the tracheostomy during and immediately after swallow, as the exhalatory airflow after the swallow may contribute to clearance of residual food from the top of the airway, reducing the chance of aspiration after the swallow.

Answer: (D)

When a patient has a tracheostomy, protecting the airway during swallowing hinges on restoring airflow through the upper airway and supporting airway closure. Occluding the tracheostomy during the swallow helps re-establish normal airway pressures and laryngeal protection. By blocking the tracheostomy, exhaled air is directed through the upper airway, which aids glottic closure and allows the subglottic space to generate pressure during the swallow. Immediately after the swallow, continuing occlusion means the exhalatory effort moves through the larynx rather than escaping via the tracheostomy, helping to clear any residual material from the laryngeal inlet and reducing the chance of post-swallow aspiration. This approach aligns airway protection with residue clearance, making swallowing safer for someone with a tracheostomy.

Positioning at an extremely large angle isn’t a standard guideline, cervical auscultation is not a reliable method to determine aspiration, and claiming there’s no risk of aspiration without occlusion overlooks the ongoing airway protection needs during and after the swallow.