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In This Section The Passy-Muir speaking valve is commonly used to help patients speak more normally. This one-way valve attaches to the outside opening of the tracheostomy tube and allows air to pass into the tracheostomy, but not out through it. The valve opens when the patient breathes in. When the patient breathes out, the valve closes and air flows around the tracheostomy tube, up through the vocal cords allowing sounds to be made. The patient breathes out through the mouth and nose instead of the tracheostomy. Some patients may immediately adjust to breathing with the valve in place. Others may need to gradually increase the time the valve is worn. Breathing out with the valve (around the tracheostomy tube) is harder work than breathing out through the tracheostomy tube. Patients may need to build up the strength and ability to use the valve, but most children will be able to use the speaking valve all day after a period of adjustment. How to use the Passy-Muir Speaking Valve:
Special Considerations:
Care of the Valve:
Safety Precautions:
Ventilator UsersFor some patients, a tracheostomy tube alone may not be enough. The tube may need to be connected to a breathing machine (ventilator) that provides a mixture of gases for life support. Patients on ventilators can speak as long as the tracheostomy tube allows flow through the larynx and vocal cords. However, the speech patterns of ventilator users present particular problems. Because of the design of the ventilator, speech occurs during the expiratory cycle of the ventilator. Then there is a long silence until the next cycle of the ventilator. During this silence, the patient may lose his or her turn to talk as conversation partners fill the silence with their own speech. Listeners may also find it hard to follow the patient's speech because the normal rhythm of conversational give-and-take is disrupted. Spoken phrases may have sudden bursts of loudness, reduced loudness at the end of phrases, and changes in voice quality because pressure in the trachea from the ventilator gases is not as stable as in typical speech production. Recent research has indicated that the speech of patients on ventilators may be improved by making simple adjustments to ventilator settings, particularly if no other problems exist besides breathing insufficiency. There is also at least one speaking valve available that can be used with a ventilator. Speech-Language Pathologist and the Rehabilition TeamThe multiple and interconnected decisions that need to be made for patients with tracheostomies or ventilators cannot be made by one professional. Physicians, nurses, respiratory therapists, dietitians, speech-language pathologists, and others must all work together to choose the options that best meet the patient's total health needs. The speech-language pathologist assesses the patient's cognitive and language abilities to determine communication potential, evaluates oral-motor and swallowing functions, and assesses the patient's ability to produce voice in different situations that may include using a speaking valve. Whatever mode of communication is recommended for the patient in the context of his or her other needs, the speech-language pathologist plays a central role in ensuring that patients and caretakers know how maximum communication can be achieved. Speech-language pathologists also treat problems of swallowing when indicated. Make an extra effort to talk with the patient, even if he/she cannot vocalize. If the patient is not able to vocalize, plan for alternative methods of communication. Alternative methods include sign language, picture cards, and communication boards. Tracheostomy Questions? E-mail Whether you're crossing the country or the globe, we make it easy to access world-class care at Johns Hopkins. Why does a PMV pop off?This is because the air being exhaled is now going through the throat, instead of out of the tracheostomy tube, and they are feeling secretions that are in the throat. Sometimes they will cough hard enough that the Valve will pop off the tracheostomy tube.
How long can you wear a PMV?The PMV should last at least two months if you care for it properly. If the PMV becomes sticky, noisy or vibrates during use, it is time to replace it. Need suctioning – Remove the PMV and suction/ cough as needed. The cuff is not deflated completely – Immediately remove the PMV and deflate the cuff completely.
What is a PMV trial?∎ Passy-Muir Valve (PMV) enables patient to vocalize without use of fingers or trach. caps. ∎ PMV is a “no leak” one-way speaking valve that allows air in through the trach on. inhalation and blocks air escape through the trach on exhalation.
How do you place a PMV?Place PMV on trach hub: keep one hand on the trach flange to maintain trach tube position in airway, without creating pressure to the trachea or discomfort for the patient. 5. Give valve ¼ turn clockwise. Do not place PMV on forcefully, as this will make it difficult to remove.
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