Passy Muir Valve Speaking Valve for Tracheostomy Patients Deidre Dennison, RN Vascular Intensive...
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Transcript of Passy Muir Valve Speaking Valve for Tracheostomy Patients Deidre Dennison, RN Vascular Intensive...
Passy Muir ValveSpeaking Valve for Tracheostomy Patients
Deidre Dennison, RNVascular Intensive Care
How it Works Contraindications
Benefits
Initiation Making Connections
References
Indications
Invented in 1985 by David Muir – 23 year old quadriplegic with muscular dystrophyUnique, one-way speaking valve allows patients to inhale through the speaking valve “No leak” design prevents air from escaping through or around the valve Forces exhaled air up over the vocal cords and through the oronasopharynx Design allows a column of air to be trapped within the valve/tracheostomy space preventing secretions from moving into the tracheostomy and occluding the PMVAvailable for use in pediatric and adult patientsMay be applied directly to the tracheostomy with/without oxygen or in-line with the ventilator circuit
Inability to tolerate cuff deflation – cuff MUST be deflated
Severe airway obstruction
Medical/hemodynamic instability
Foam –filled cuffed tracheostomy tube
Severely non-compliant lungs
Unmanageable secretions
Endotracheal intubation
Not to be used while sleeping
Helps to restore more natural “closed respiratory system” Allows patients to regain the ability to communicate and participate more effectively in the plan of careImproves swallowRestores intrinsic PEEP (positive end expiratory pressure) facilitating better oxygenationReduces tracheal suctioning by assisting patients in developing a more effective coughAids in ventilator weaning by returning use of the diaphragm and respiratory muscles during exhalation and speakingAllows patients to regain strength & sensation in upper airwayBuilds confidence and improves quality of lifeFacilitates pediatric language developmentMay be used on and off the ventilator
Requires a multidisciplinary approach involving collaboration between the Speech-Language Pathologist, Physician, Respiratory Therapy, and the Registered Nurse
Initial assessment includes the patient’s ability to tolerate cuff deflation – the cuff must ALWAYS be deflated while using the Passy-Muir valve. Failure to do so will prevent inhaled air from being exhaled as it will not be able to pass through the upper airway or out of the tracheostomy tube
Quantity and quality of secretions should be considered as the patient will be learning to deal with them differently, for example during a respiratory infection, after mucolytics or after pulmonary tolieting
Assessment of airway patency and the patient ‘s ability to breathe around the tracheostomy tube and deflated cuff should be performed prior to placement of the Passy-Muir valve
Employed in a variety of settings including rehabilitation, sub-acute care, as well as intensive care; may be initiated as early as 72 hours post tracheostomy
Appropriate education for patients regarding change in airways pressure, sensation of upper airway, and change in secretion management should be performed in order to reduce patient anxiety
Quadriplegia
Mechanically ventilated/dependent patients
Tracheomalacia
Neuromuscular disorders
Head trauma
COPD
Mild tracheolaryngeal stenosis
Bedside assessment before, during, and after valve placement includes: changes in patient’s breathing pattern, work of breathing, oxygen saturation, heart rate, secretions, color & mental status, and patient reaction
Patient should be sitting in a semi-Fowler’s or Fowler’s position in order to maximize lung expansion and diaphramatic movement
Suctioning should be performed prior to valve placement as needed; suctioning while slowly deflating the tracheostomy cuff may help prevent pooled secretions from entering the lower airway
Off the ventilator, the PMV fits directly onto the tracheostomy tube hub; may also be used with humidified oxygen via a trach collar or an oxygen cannula via a PMV oxygen adapter
When used during mechanical ventilation the PMV 007 (Aqua) fits directly into the disposable ventilator tubing; other PMV models require non-disposable tubing
Requires ventilator alarm adjustments including low volume alarms as the patient is exhaling volumes through the upper airway instead of returning it to the ventilator
May be utilized with most conventional modes of ventilation including pressure control (PC), assist/control (AC), pressure support ventilation (PSV), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP)
Passy-Muir tracheostomy and ventilator speaking valve resource guide. Passy-Muir Inc., October 1997; revised March, 2003.
Hess, D. (2005). Facilitating speech in the patient with a tracheostomy. Respiratory Care, 50(4), 519-525.