Heparin lock for nighttime intravenous fluid management in a dysphagic patient

Dysphagia, with its inherent risk of aspiration, is a clinical problem frequently encountered in patients with brain injury from trauma or cerebrovascular accident. The use of nasogastric tubes and intravenous lines for nutrition and hydration can be cumbersome and uncomfortable for the patient, and can interfere with rehabilitation therapy. With the advent and increased use of video- and cinefluoroscopy to evaluate swallowing, the type of dysphagia can be defined more readily. This article describes the use of a heparin lock at night to provide fluids intravenously to a patient who could swallow solid or semisolid food, but aspirated thin liquids. This approach insured adequate hydration while keeping the patient free of parenteral lines and nasogastric tubes during therapy. This technique was continued for 3 1/2 weeks until the patient's dysphagia improved and a full oral diet could be resumed. The authors recommend the use of nighttime intravenous feeding via a heparin lock as an option for managing this subset of dysphagic patients in a rehabilitation setting.