Transcript TRACHEOSTOMIES AND THE PASSYMUIR VALVES

TRACHEOSTOMIES AND PASSYMUIR VALVES
San Francisco General Hospital
and Trauma Center
Department of Speech-Pathology
WHY ARE PATIENTS
TRACHED?
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ASPIRATION, DYSPHAGIA
FAILED EXTUBATION
GSW TO FACE, JAW, THROAT
WIRED JAW DUE TO FRACTURE
COPD
NEUROLOGICAL DISORDERS
ANATOMY CHANGES (STENOSIS,CA)
WHAT DOES A TRACH DO?
ALLOWS REMOVAL OF
SECRETIONS
 ALLOWS EXCHANGE OF AIR
 MAY OR MAY NOT HELP PREVENT
ASPIRATION OF SECRETIONS
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CUFFED TRACH TUBES
HAVE A BALLOON AROUND THE END
OF THE TRACH TUBE
 REQUIRED FOR PATIENTS ON
VENTILATORS
 PREVENT PATIENT FROM VOICING
 MAKE IT DIFFICULT TO SWALLOW
 NEED ST/RT TO PLACE PMV
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RISKS OF CUFFED TRACH
TUBES
TRACHEAL MALACIA – Softening of
tracheal tissue, sometimes requiring a
graft
 TRACHEAL FISTULA - Puncture into
the trachea
 INFECTION
 SCARRING
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CUFFLESS TRACH TUBES
USED WITH PATIENTS WHO CAN
SWALLOW
 USED WITH PATIENTS WHO
REQUIRE TRACHEAL SUCTIONING
 ASSIST WITH AIRWAY PATENCY
(E.G., STENOSIS)
 PASSYMUIR VALVE CAN BE PLACED
BY ALL STAFF
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TYPES OF TRACHS
COMMONLY USED AT SFGH
SHILEY
 SIZES #8, #6 AND #4
 PROTEX TRACH TALK
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TRACH DOWNSIZING
CUFF DEFLATION TOLERATED FOR
>48 HOURS
 NO VENTILATION REQUIRED
 LIMITED TRACHEAL SUCTIONING
REQUIRED
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PROCESS OF
DECANNULATION
CUFF DEFLATION, (If patient has a
cuffed trach)
 IMPROVED SECRETION
MANAGEMENT, (Eg, decrease in
suctioning, improved cough)
 PASSY-MUIR VALVE
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WHAT DO I DO IF A TRACH
FALLS OUT??
IF THE TRACH WAS PLACED LESS
THAN 7 DAYS AGO, PAGE
ANESTHESIA
 OTHERWISE, PAGE OHNS (719-7522)
AND/OR RT
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PASSY-MUIR VALVE
EVALUATION SEQUENCE
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IDEALLY, THE TRACH PATIENT NEEDS TO
HAVE A PASSY-MUIR VALVE (PMV) EVAL
PRIOR TO A SWALLOW EVAL
 SPEECH OBTAINS ORDERS FOR CUFF
DEFLATION IF APPROPRIATE
 IF CUFF DEFLATION TOLERATED,
SPEECH/ R.T. ARE THE ONLY STAFF TO
PLACE PMV
 PMV MUST BE KEPT IN MED BOX, IF
PATIENT HAS A CUFFED TRACH
HOW DOES THE PMV WORK?
THE PMV IS A ONE WAY VALVE
 THE PMV ALLOWS AIR IN THROUGH
TRACH BUT NOT OUT
 AIR BLOWS UP THROUGH VOCAL
CORDS TO ALLOW VOICE UPON
EXHALATION
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IS THE PATIENT READY FOR
PMV OR SWALLOWING?
CAN PATIENT SIT UP AT 90
DEGREES?
 IS PATIENT ALERT ENOUGH?
 ARE THEY MOUTHING WORDS?
 CAN THEY TOLERATE CUFF
DEFLATION ?
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HOW IS SWALLOWING
DIFFERENT WITH A TRACH?
TRACH CAN ANCHOR LARYNX
DOWN
 SWALLOWING PRESSURES ARE
ALTERED
 TASTE AND SMELL CAN BE
REDUCED
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BENEFITS OF THE PMV
TALKING!
 IMPROVES SMELL,TASTE
 REDUCES RISK OF ASPIRATION
 CAN HELP WITH OXYGENATION
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MONITORING THE PMV
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OXYGEN SATURATION, HEART RATE AND
RESPIRATORY RATE ARE MONITORED
 AT TIMES, THESE NUMBERS ARE
NORMAL BUT PATIENT FEELS
BREATHLESS OR BLOWS OFF THE PMV
 TRACH TUBE(#6,#,8) MAY BE TOO LARGE
 WITH LARGER TUBES THERE IS LESS
AIRWAY SPACE IN THE TRACHEA
QUESTIONS?