TRACHS, VALVES AND SAFETY ISSUES
(reprinted from 7/6/03 News to Peruse, the OHSU nursing practice newsletter)

Speech Language Pathologists are involved in the care of patients with a trach for 3 basic reasons: trach weaning, dysphagia, and communication (speech or alternative communication). Many of the patients we see use a Passy Muir Speech Valve to produce speech as they progress in the trach weaning process, and to increase the effectiveness of their swallow. Passy Muir Valves are used with Shiley trachs, and other trachs with air filled cuffs or cuffless trachs. Passy Muir Valves are not used with metal trachs.

After a patient has been evaluated by an SLP and an order has been written in the chart to leave the cuff deflated with the Passy Muir Valve in place, guidelines are established in the order in the chart and are posted at bedside.

These guidelines typically include the following: (may vary patient to patient)
Remove valve and re-inflate cuff for:
· Decreased respiratory status, O2 <92%
· Significantly increased suction needs
· Over night
· Nausea
· On vent
· Other ____________________

Important: Cuff MUST be deflated when Passy Muir Valve is in place, remove the syringe after deflating the cuff. These one-way valves allow air to flow through the tracheostomy during inspiration. During expiration, the valve closes, routing air through the vocal cords and the upper airway, facilitating phonation. If the cuff is inflated, exhalation is prevented.

If you have any questions contact the SLP working with your patient.
Robyn Walker, SLP

Last updated January 14, 2005 by OHSU School of Nursing Web Managers.
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