Janelle Gift Z.

Senarlo 2/7/2022
BSN – 3 Mr.
Tancinco

RESEARCH: USE OF ICE CHIPS IN GI DISORDERS

Patients are usually given ice chips to keep them hydrated in hospitals. Because of surgery or other constraints, many patients
have difficulty drinking liquids. As a result, ice provides a convenient way for these individuals to stay hydrated. Based on my online
research, I discovered some of the clinical experience of healthcare workers through a website called Quora, where anyone can ask a
question and have it answered by professionals with experience, such as nurses and doctors who have performed ice chip
interventions in other countries.
Mr. Steven Gaudry (2020) stated that it allows a patient who is having surgery to have just enough moisture to keep their
esophagus moist (as the esophagus does not produce mucus) without having enough water in quantity to be a danger when
anesthetized (of throwing up and getting into the lungs). Postoperatively, it is the same idea plus the bowels may have a temporary
paralysis called "paralytic ileus" that can last for 24 to 48 hours. Patients with Xerostomia (dry mouth) and oral mucosal superficial
lesions may also benefit from the cool ice chips during chemotherapy.
Ms. Anne Brown (2021) mentioned that it appears that everyone has commented on why you'll get chips before surgery, and
I'm not going to add anything to that. Many others in the hospital are suffering from swallowing problems as a result of strokes and
neurological damage. My mother-in-law was in the hospital near the conclusion of her battle with breast cancer, unable to swallow due
to tumors in her neck. She would have aspirated and sucked water into her lungs if she had been exposed to water. She might,
however, have ice chips. I spent many hours with a spoon feeding her chips, which offered her relief. On her lips, I applied Vaseline
and Chap Stick.
Ms. Nicole Macdonald (2020) People tend to suck or bite ice chips, so they might be gradually introduced into your
gastrointestinal system. Taking large sips of water during anesthesia can cause you to aspirate (breathe it in) or choke on the water
that comes back up. As a result, prior to surgery, patients are given ice chips . They were once only provided to pregnant women, but
many doctors now allow their patients to drink tiny cups of clear liquids. They'll give you ice chips until you're cleared for drink and/or
food after surgery.
Ms. Chesterton (2020) indicated that it does not happen very often, but it does depend on the conditions . Ice chips aren't
required for all patients. Before or after a surgery or other invasive operation, a patient may be administered ice chips. They can
moisten the tongue without putting liquids in the stomach if administered sparingly before surgery. The small amount that makes its
way there is swiftly absorbed by the stomach lining. Ice chips may be used in a clear liquid diet after surgery. This method of gradually
increasing fluid intake can help reduce nausea and vomiting. They also assist chemo patients avoid mouth sores. Chips can be used
as a first-line treatment for chronic vomiting that is causing dehydration, as well as in conjunction with IV hydration. They can be used
whenever you want to keep your mouth moist without putting liquids in your stomach.
Mr. Marshall (2020) mentioned that nausea and vomiting are a potential concern following surgery. As a result, it's crucial to
start introducing fluids and food gradually, as the patient tolerates. Ice chips are chilly and provide the maximum satisfaction in terms of
relieving thirst while consuming the least amount of drink. They are, for the most part, the greatest option for introducing fluids after
surgery.
Mr. Rosen (2019) claimed that anesthetic medicines cause patients to have a dry mouth. Patients may also have throat
soreness as a result of the breathing tube after surgery. Ice chips keep your mouth cool and wet without filling up your stomach with
water. People who have had surgery should take it easy, and we don't want them to eat too much too soon. To put it another way, if
you have a dry and sore throat, 10 ice chips may last you 30 minutes and bring comfort. On the other hand, half a glass of water, which
is theoretically the same volume, would likely go down swiftly and leave you with little relief from your dry mouth or throat pain. Finally,
many patients may experience nausea in addition to a sore throat and dry mouth, and ice chips are an excellent technique to gradually
introduce water into the stomach without risking vomiting or increasing nausea.
In 2018, Jessica M. Pisegna and Susan E. Langmore published The Ice Chip Protocol: A Description of the Protocol and Case
Reports, which I read online. The ideal patient for the Ice Chip Protocol is someone with suspected severe dysphagia or unclear
swallowing capacity, according to the researchers. When the doctor is unsure about the patient's capacity to swallow properly and/or
the patient has advanced pulmonary disease, ice chips are ideal. Because these patients are prone to aspiration, the assessment
should be careful and include a benign bolus such as an ice chip. Any patient who is currently tube fed is a suitable candidate for the
Ice Chip Protocol, according to the researchers, because these patients may have severe dysphagia and have not swallowed any food
or fluids for an extended period of time. In fact, tube-fed patients have been demonstrated to have a decreased frequency of
swallowing than patients who are fed orally, to the point where secretions are not managed (Crary & Groher, 2006). Candidacy for the
Ice Chip Protocol is also determined by the patient's present swallow status in terms of how often the swallow is engaged: normal,
decreased, or nonuse. Researchers define "reduced use" as executing a swallow less than someone with regular oral feeds, with only
occasional engagement (such as limited tastes of food/liquid). “ Normal use" as executing a swallow less than someone with regular
oral feeds, with only occasional engagement (such as limited tastes of food/liquid). Researchers believe that "reduced use" can range
from modest to severe. Finally, "nonuse" of the swallow is defined as practically complete nonuse of the swallow, such as in an
intubated or surgical patient who is unable to swallow volitionally and requires suctioning.
It was also reported that ice chips have unique and advantageous qualities. For starters, they're a small, manageable volume,
ranging in size from a pea to a pencil eraser (5–7 mm). Each ice chip contains about 1 milliliter of melted water, according to their
calculations. Because they are small and contained entities, the physician may easily manage the amount of bolus on the spoon and
the amount swallowed by the patient. Ice chips, on the other hand, are a solid bolus. Ice chips are simple to manipulate and hold in
one's mouth. They allow for the oral preparatory phase of swallowing to be engaged , which stimulates cortical structures and their
involvement in aiding bolus transit and swallow start. They're easier to handle than a drop of water, and they can be driven into the
pharynx before melting. The patient's reaction to one ice chip in their mouth reveals a lot about their oral control and capacity to
swallow voluntarily. Ice chips are a refreshing, comforting bolus. Patients often say that the cold ice "tastes delicious," and one study
found that having access to water and ice chips was related with a higher quality of life. (Karagiannis & Karagiannis, 2014). A much
more complicated process lies beneath the enjoyment. Temperature, chemoreceptor, and tactile receptors in the mouth are stimulated
by a cold solid bolus. As the ice is held in the oral cavity, afferent routes to the brainstem, subcortical, and cortical areas are stimulated.
Fourth, they believe that little ice chips are advantageous since they are relatively harmless when inhaled. Because the ice pieces are
so small, one of them cannot obstruct the glottis and hence is not a choking concern . The Ice Chip Protocol is based on the same
tenants of any water protocol: Clean water, in and of itself, is not harmful to the lungs (Holas, DePippo, & Reding, 1994; Robbins et al.,
2008). According to water protocols, provided a patient's mouth is kept clean, a tiny amount of water aspiration should not be
hazardous to the patient. They argue that the same logic applies to modest, regulated amounts of ice chips, and that ice chips have
additional benefits in diagnosing and treating dysphagia.
The point of the article was to describe the theoretical basis of an ice chip protocol that has been proposed. The clinical
experience demonstrates that the Ice Chip Protocol is a safe and effective method for evaluating and rehabilitating dysphagia in cases
when previous boluses have failed. The Ice Chip Protocol is efficient in lowering secretions and measuring the oral and pharyngeal
stages of swallowing in a safe and functional manner, according to their case studies. Furthermore, they presented several anecdotal
situations in which ice chips were utilized in a rehabilitative manner to help patients regain swallowing function. Other countries appear
to be employing a similar ice chip activity for swallowing rehabilitation in severely dysphagic individuals. (A. Kaneoka, personal
communication, April 10, 2015). However, it was also mentioned that the Ice Chip Protocol's outcomes have been mostly unstudied.
There was only one published study: a presentation from 2011 that described two small groups of patients who received ice chips as
part of a FEES regimen. Aspiration on ice chips was linked to aspiration on thin liquids, as well as a diet suggestion, according to the
researchers (Kaszuba, Brady, Wesling, Donzelli, & Stewart, 2011).
The findings of the study show the benefit of using ice to test for aspiration risk before administering more challenging
boluses. Other outcomes, such as the safety of using ice chips for evaluation and rehabilitation efficacy, are still unknown. To aid in the
dissemination and execution of the Ice Chip Protocol, a list of frequently asked questions from a variety of professionals has been
compiled. It's worth noting that, in most cases, eating ice chips was considered as a technique of moving from a NPO status to oral
consumption of liquids and food, rather than a therapy aim. Ice chips were typically used as a practice bolus to activate the swallowing
mechanism and build strength until other meals and beverages could be safely consumed. The Ice Chip Protocol is designed to aid
doctors in analyzing a swallow, particularly in patients who have severe dysphagia or are on NPO . Patients were given ice chips in the
majority of case reports, and they showed an overall decrease in pharyngeal secretions, as well as success transitioning to food and
beverages by mouth. The Ice Chip Protocol appears to be an effective and safe procedure, but it would benefit significantly from formal
research to determine its safety, value, and effects.
Basically, I had no idea that ice chips could help with gastro intestinal problems. I just know that it helps to keep our mouths
moistened, but there's more to it than that. The first article I read described how ice chips aided many nurses, particularly during patient
perioperative surgery, particularly for gastro intestinal diseases. It really increased my understanding of the applications and benefits of
it, which I may pass on to my future patients. Actually, I'm having a hard time finding studies on ice chips and gastrointestinal issues,
although I did find one case report in 2018. I'm delighted the report included images and actual findings from their nine patients. I
understand how difficult it is, but being able to write a case report that will benefit many future healthcare professionals was incredibly
useful. I'm grateful I read it because the researchers hoped that future studies would use the proposed standardized protocol to carry
out the Ice Chip Protocol and formally study its crucial clinical outcomes related to dysphagia.

REFERENCES:
Brown A., Chesterton K., Gaudry S., MacDonald N., Woolner M., (2020, 2021) https://www.quora.com/Why-do-hospitals-often-give-
patients-ice-chips-rather-than-liquids-when-they-are-thirsty
Langmore S. and Pisegna J., (2018); Article: The Ice Chip Protocol: A Description of the Protocol and Case Reports - Perspectives of
the ASHA Special Interest Groups, DOI: 10.1044/persp3.SIG13.28
Rosen D., (2019) https://www.quora.com/Why-are-patients-given-ice-chips-after-surgery