T.A. asks, "If a patient uses a cap or a valve in order to speak, should the cuff be inflated or deflated?"
Answer: The purpose of the cuff is to seal the airway, and the ability to phonate depends upon air reaching the vocal cords. So the ability to speak depends on cuff deflation. If a cap is applied to a tube with an inflated cuff, the patient will be completely unable to inhale nor exhale. If a valve is applied to a tube with an inflated cuff, the patient will be able to inhale through the valve, but will be unable to exhale.
Ideally, a cuffless tube should be used when placing a cap or valve. A cap should NEVER be applied to a cuffed tracheostomy tube, even if the cuff is completely deflated. A valve may be applied to a cuffed tracheostomy tube, but only when the cuff is completely deflated and when the ability to breathe comfortably has been thoroughly assessed.
This concept is imperative for health professionals to understand:
Cap or valve + Inflated cuff = Asphyxia
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This is often a matter that is not brought to the forefront in hospital care. It appears that tracheostomy procedures are becoming more common than in the past. Is there a resource to better educate the patient or a family that has a loved one with a trach that you would recommend?
ReplyDeleteMy son has a pediatric trach. We've done most of our research online and ried to become good friends with respiratory therapists. It's not very common to see child with a trach here, so the hospital staff get nervous when we walk in. Lol.
ReplyDeleteAnyways, he has a passy muir valve. The problem we run into the most with it has to do with secretions. My son sometimes isn't strong enough to pass the secretions around the deflated tube (wears a cuff less Bivona). And he cannot swallow correctly and never has een able to, so he coughs quite a bit with it on. Then there's also the factor that the only humidity he would get with it on would be the humidity in the air since we have the humidity equipment as a stationary set up for night and use HMEs through the day.
A valve is probably more for the people who have been able to talk in the past and miss it (I know I would miss speaking), but I have found it VERY helpful in the speech therapy and development issue for my son. He's had the valve fir six months and can only wear it sporadically throughout the day.
My apologies for the late replies. Regarding the first comment: Yes, tracheostomies are being done more frequently in hospitals these days, for a lot of reasons, primarily that a tracheostomy has several advantages over other ways to manage a patient. In terms of a tracheostomy resource, there is, of course, our book: Tracheostomies: The Complete Guide (Morris & Afifi, 2010, NY: Springer). It is primarily written for health professionals, but patients themselves have found it useful.
ReplyDeleteThere are also some websites that provide a fair amount of good information for patients and families, one of them is www.tracheostomies.com. It would also be a good idea to check with your local hospital, who might have written materials they can provide.
Speaking valves do play an important role in the development of speech in children with tracheostomies. Secretions can build up in the valve, rendering it ineffective. Be sure to clean it on a regular basis by soaking it in warm soapy water to loosen secretions.
ReplyDeleteOur passy muiri is closed valve. So any secretions, when he exhales, go up around the trach and into the mouth where he spits it out. I just rinse it off with warm water ever couple days just in case it has germs on it. The only problem we have is when he tries inhaling his saliva and it won't let him. It makes him cough.
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