1. TRACHEOSTOMIES AND PASSY- MUIR VALVES San Francisco General Hospital and Trauma Center Department of Speech-Pathology

2. WHY ARE PATIENTS TRACHED? ASPIRATION, DYSPHAGIA FAILED EXTUBATION GSW TO FACE, JAW, THROAT WIRED JAW DUE TO FRACTURE COPD NEUROLOGICAL DISORDERS ANATOMY CHANGES (STENOSIS,CA)

3. WHAT DOES A TRACH DO? ALLOWS REMOVAL OF SECRETIONS ALLOWS EXCHANGE OF AIR MAY OR MAY NOT HELP PREVENT ASPIRATION OF SECRETIONS

5. 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

6. RISKS OF CUFFED TRACH TUBES TRACHEAL MALACIA – Softening of tracheal tissue, sometimes requiring a graft TRACHEAL FISTULA - Puncture into the trachea INFECTION SCARRING

7. 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

8. TYPES OF TRACHS COMMONLY USED AT SFGH SHILEY SIZES #8, #6 AND #4 PROTEX TRACH TALK

9. TRACH DOWNSIZING CUFF DEFLATION TOLERATED FOR >48 HOURS NO VENTILATION REQUIRED LIMITED TRACHEAL SUCTIONING REQUIRED

10. PROCESS OF DECANNULATION CUFF DEFLATION, (If patient has a cuffed trach) IMPROVED SECRETION MANAGEMENT, (Eg, decrease in suctioning, improved cough) PASSY-MUIR VALVE

11. 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

12. PASSY-MUIR VALVE EVALUATION SEQUENCE 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

13. 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

14. 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 ?

15. HOW IS SWALLOWING DIFFERENT WITH A TRACH? TRACH CAN ANCHOR LARYNX DOWN SWALLOWING PRESSURES ARE ALTERED TASTE AND SMELL CAN BE REDUCED

16. BENEFITS OF THE PMV TALKING! IMPROVES SMELL,TASTE REDUCES RISK OF ASPIRATION CAN HELP WITH OXYGENATION

17. MONITORING THE PMV 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

18. QUESTIONS?