Dangers with Caps and Speaking Valves

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