Page 211 - Clinical Application of Mechanical Ventilation

Airway Management in Mechanical Ventilation 177

SPEAKING VALVES

Fenestrated tracheostomy tubes have been in use for many years to facilitate wean-
ing of tracheostomy tube and to allow phonation (Mallinckrodt, 2011). With the
airway opening of a fenestrated tracheostomy tube blocked or plugged, the small
fenestrated openings along the body of the tube allow the patient to move air
through the vocal cords making phonation possible (Figure 6-19).
speaking valve: A one-way valve A speaking valve is a device which consists of a one-way valve that fits on a tra-
attachment to the tracheostomy ditional or fenestrated tracheostomy tube over a 15-mm connection. The one-way
tube that allows the user to talk.
valve allows the patient to breathe in, but exhaled air is blocked and diverted around
the deflated cuff or fenestrations. The air moves through the vocal cords making
phonation possible (Figure 6-20). Some common speaking valves are the Passy-
Speaking valves block
the exhaled air through the Muir (Passy-Muir Inc., Irvine, CA), the Phonate (Mallinckrodt, 2011), and the
tracheostomy tube and direct Montgomery and Ventrach speaking valves (Boston Medical Products, 2012).
it through the vocal cords
making phonation possible.
Contraindications

Contraindications for using a speaking valve include laryngeal stenosis, vocal cord
Contraindications for paralysis, and severe tracheal stenosis. These conditions impede airflow making
using speaking valve include
laryngeal stenosis, vocal cord ventilation and phonation difficult (Mallinckrodt, 2011).
paralysis, and severe tracheal
stenosis.
Safety Requirements

Before the speaking valve is placed on a cuffed tracheostomy tube, the cuff must
The design of the first be deflated. An inflated cuff would make exhalation through the tracheostomy
speaking valve allows only
inhalation through the tube impossible because the design of the speaking valve allows only inhalation,
tracheostomy tube, but not but not exhalation. A deflated cuff would allow the patient to exhale around the
exhalation.
tracheostomy tube, through the vocal cords and the mouth or nose.

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Figure 6-19 A fenestrated tracheostomy tube.

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