What is level 2 thickened fluid? An IDDSI Guide

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global framework, level 2 thickened fluid is officially classified as 'Mildly Thick'. This specific consistency is prescribed by healthcare professionals for individuals with dysphagia to help reduce the risk of choking and aspiration.

Quick Summary

Level 2, or mildly thick fluid, is designed to be sipped from a cup and poured quickly from a spoon. This consistency is crucial for promoting safer swallowing for people with dysphagia.

Key Points

• Definition: Level 2 thickened fluid is officially called 'Mildly Thick' under the IDDSI framework and was previously known as 'nectar thick'.

• Purpose: It is prescribed for individuals with dysphagia (swallowing difficulties) to slow the flow of liquid and prevent aspiration.

• Characteristics: This fluid can be sipped from a cup and through a straw with mild effort, but pours slower than thin liquid and is lump-free.

• Testing Method: The consistency must be verified using the IDDSI Flow Test with a 10mL syringe, which should retain between 4-8mL of liquid after 10 seconds.

• Preparation: Use a commercial thickener, following the manufacturer's instructions carefully, and test the final product to ensure safety.

• Safety Precautions: Avoid foods that melt into thin liquids, discard old thickened fluids, and always consult a speech-language pathologist for guidance.

The Importance of the International Dysphagia Diet Standardisation Initiative (IDDSI)

Before the IDDSI framework, inconsistent terminology for modified diets across healthcare settings created safety risks for people with dysphagia. The IDDSI was developed by experts to establish a universal language and testing methods for texture-modified foods and liquids, improving patient safety.

Why are thickened fluids necessary?

Individuals with dysphagia may have difficulty swallowing thin liquids, which can accidentally enter the airway (aspiration). Aspiration can lead to serious health issues like pneumonia. Thickening liquids slows their flow, allowing better control during swallowing.

What are the characteristics of level 2 thickened fluid?

IDDSI Level 2, or Mildly Thick, has specific characteristics. It is comparable to the older 'nectar thick' consistency.

Key characteristics of Level 2 fluid include:

• Sippable from a cup.
• Requires mild effort to use a standard straw.
• Smooth and lump-free.
• Flows quicker than thicker liquids but slower than water when poured.
• Leaves a thin coating on a spoon.

How to test for the correct Level 2 thickness

The IDDSI Flow Test is the recommended method to verify consistency using a 10 mL syringe.

Testing method:

1. Remove the plunger from a 10 mL syringe.
2. Cover the syringe nozzle with a finger.
3. Pour 10 mL of the liquid into the syringe.
4. Over a cup, start a timer and release the nozzle.
5. After 10 seconds, cover the nozzle.
6. Measure the remaining liquid; for Level 2, it should be 4-8 mL.

Comparison of IDDSI Liquid Thickness Levels

IDDSI Level	Terminology	Characteristics	Former Terminology (NDD)	Syringe Flow Test (mL remaining)
Level 0	Thin	Flows like water; fast flow.	Thin	< 1 mL
Level 1	Slightly Thick	Thicker than water; requires a little more effort to drink.	-	1-4 mL
Level 2	Mildly Thick	Can be sipped from a cup; sippable from a standard straw with effort.	Nectar-Thick	4-8 mL
Level 3	Moderately Thick	Flows slowly from a cup; liquid is poured or spooned.	Honey-Thick	> 8 mL

Preparing level 2 thickened fluid

Preparation involves using a prescribed commercial thickening powder. These are available commercially.

Steps for preparation:

1. Gather equipment: Cup, thickener, liquid, and scoop.
2. Add thickener: Place the recommended amount of thickener into the dry cup. Ratios vary; follow product instructions.
3. Pour and stir: Add liquid and stir vigorously for about 30 seconds. A fork can help prevent lumps.
4. Wait: Allow 1-2 minutes for the fluid to thicken.
5. Check thickness: Confirm Level 2 consistency with the IDDSI Flow Test.

Important considerations and safety tips

• Hydration: Monitor fluid intake and discuss concerns with a healthcare provider.
• Avoid melting solids: Do not consume foods that become thin liquids, like ice cream.
• Discard fluids: Discard thickened fluids after 6 hours at room temperature or 24 hours refrigerated as consistency can change.
• Straw use: A speech-language therapist should confirm straw use is safe.
• Professional consultation: Thickened fluid prescriptions and levels should be determined by a speech-language pathologist.

Conclusion

Level 2 thickened fluid is a crucial component of dysphagia management, promoting safer swallowing by slowing liquid flow and reducing aspiration risk. Adhering to IDDSI guidelines and proper preparation methods ensures safe and consistent fluid intake. Always consult healthcare professionals for personalized recommendations. More information on IDDSI can be found at IDDSI.org.

Frequently Asked Questions

What is the IDDSI framework?

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global framework with standardized terminology and testing methods for texture-modified foods and thickened liquids used for people with dysphagia.

Why is Level 2 thickened fluid needed?

It is needed for individuals with dysphagia whose mouth or throat muscles are uncoordinated, which can cause thin liquids to enter the airway (aspiration), potentially leading to chest infections or pneumonia.

Can I drink Level 2 thickened fluid through a straw?

Yes, Level 2 fluid can typically be drunk through a standard straw, but it requires more effort than thin liquids. You should always confirm with a speech-language therapist that it is safe for you to use a straw.

What happens if I don't mix the thickener correctly?

If the thickener is not mixed correctly, the fluid can become lumpy, which can increase the risk of choking. If lumps appear, do not add more thickener, but start over with a fresh cup and liquid.

Are there any drinks I should avoid on a Level 2 diet?

Yes, you should avoid any food or drink that becomes thin at room temperature, such as ice cream, gelatin, or sherbet. This is because they can change consistency and become unsafe.

How do I make sure the fluid stays the right consistency?

Thickened fluids can change consistency over time or if left out. To ensure safety, it is recommended to discard any prepared thickened fluid after 6 hours at room temperature or 24 hours if refrigerated.

Can I use cornflour to thicken sauces instead of a commercial thickener?

While cornflour is a thickener, healthcare professionals typically prescribe commercial thickeners for drinks to ensure a consistent and safe consistency. Always follow the advice of your speech-language pathologist and the instructions for your prescribed product.