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TRACHEOSTOMIES AND PASSY-MUIR VALVES

TRACHEOSTOMIES AND PASSY-MUIR VALVES. San Francisco General Hospital and Trauma Center Department of Speech-Pathology. WHY ARE PATIENTS TRACHED?. ASPIRATION, DYSPHAGIA FAILED EXTUBATION GSW TO FACE, JAW, THROAT WIRED JAW DUE TO FRACTURE COPD NEUROLOGICAL DISORDERS

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TRACHEOSTOMIES AND PASSY-MUIR VALVES

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  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

  4. 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

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

  6. 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

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

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

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

  10. 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

  11. 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

  12. 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

  13. 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 ?

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

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

  16. 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

  17. QUESTIONS?

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