Healthcare Choking Aspiration Protocol

HEALTHCARE CHOKING AND ASPIRATION MANAGEMENT PROTOCOL

Patient Information

Risk Assessment and History

The following risk factors that increase the likelihood of choking or aspiration have been assessed. Check all that apply and provide pertinent details.

Swallowing Status, Diet and Feeding Orders

Current swallowing status and prescribed diet modifications intended to reduce aspiration risk.

Emergency Management Procedures

The following stepwise procedures must be followed if choking or aspiration is suspected. Staff shall act promptly and document all interventions and patient responses.

A. Conscious Adult and Child

1. Assess airway, breathing and responsiveness. If the patient is coughing effectively, encourage continued coughing and monitor airway. If ineffective cough or silent airway obstruction, proceed immediately with the following sequence: five back blows followed by five abdominal thrusts (Heimlich maneuver). Repeat cycles until obstruction clears or the patient becomes unresponsive.

2. For pregnant or morbidly obese patients, perform chest thrusts rather than abdominal thrusts.

B. Conscious Infant (under 1 year)

Alternate five back blows with five chest compressions (using 2 fingers) while maintaining head-down support. Do not perform abdominal thrusts on infants.

C. Unresponsive Patient

If patient becomes unresponsive, call for emergency response immediately, begin CPR per current resuscitation guidelines, and attempt ventilation. Before rescue breaths, inspect the oral cavity for visible obstruction and remove only if material is visible and can be removed without blind finger sweeps. Continue advanced airway management per clinician competency.

D. Suspected Aspiration without Complete Obstruction

1. Position patient to protect airway: lateral recovery position if airway protective reflexes present. If decreased consciousness, turn head to the side and suction as needed. 2. Suction oropharynx and, if trained and ordered, perform oral suctioning or nasopharyngeal suctioning. 3. Administer supplemental oxygen and monitor oxygen saturation. 4. Notify responsible clinician for evaluation and orders (chest imaging, antibiotics if aspiration pneumonia suspected, or advanced airway if indicated).

Contraindications and Limits

Do not perform abdominal thrusts on pregnant patients; use chest thrusts. Do not perform blind finger sweeps. Respect documented advance directives (Do Not Resuscitate, Do Not Intubate) and physician orders specifying limitations to airway interventions.

Equipment Checklist

Ensure the following equipment is immediately available at bedside when risk is present. Check items below and initial where indicated.

Documentation and Notification

All choking or aspiration events, attempted maneuvers, patient response, and notifications must be documented promptly in the medical record. Notify the attending physician and the patient's designated decision-maker as soon as practical. If a resuscitation was required, complete incident reporting per facility policy.

Staff Training and Competency

Only staff who have documented competency in choking first aid, CPR, and airway suctioning (as appropriate to scope) shall perform emergency maneuvers. Dates and initials of trained staff must be maintained.

Physician / Clinician Orders (if applicable)

Use this section to record specific physician orders related to choking and aspiration management. Orders entered here should be confirmed in the medical record.

Patient Acknowledgement and Certification

By signing below the patient or legally authorized representative acknowledges that the choking and aspiration management plan has been explained, understands the risks of aspiration and interventions that may be performed in an emergency, and acknowledges the right to accept or refuse specific interventions consistent with advance directives. This acknowledgement does not replace standing medical orders or documented advance directives.

Sign Now