Page 212 - Clinical Application of Mechanical Ventilation

178 Chapter 6

Expired Air

Vocal Cords
Tracheostomy with
Cuff Deflated
Inspired Air Copyright 2003 AARC Times Magazine, a publication of the American Association for Respiratory
Esophagus
Speaking Valve
Care. Reprinted with permission.
Trachea

A B

Figure 6-20 (A) Speaking valve. (B) The one-way valve dose not allow exhalation through the
tracheostomy tube. The exhaled air is directed toward the vocal cords making phonation possible.

Before the speaking valve is placed on a fenestrated tracheostomy tube, the fenes-
Before the speaking valve trations must be opened by removing the nonfenestrated inner cannula or using a
is placed on a fenestrated
tracheostomy tube, the fen- fenestrated inner cannula. The cuff of the fenestrated tracheostomy tube may be
estrations must be opened by inflated or deflated. This technique allows the exhaled air to move toward the vocal
removing the nonfenestrated
inner cannula or using a cords and the mouth or nose (Pruit, 2003). Table 6-9 summarizes the safety require-
fenestrated inner cannula.
ments in using a speaking valve on a tracheostomy tube.
Positive Pressure Ventilation

Air leak is common when using a speaking valve. For patients who are breathing
spontaneously, the amount of air leak is of no concern. In mechanically ventilated
patients, the air leak may require careful and periodical adjustments of the tidal
volume, PEEP, and alarm settings (Pruitt, 2003). To ensure adequate ventilation
and oxygenation, the vital signs and pulse oximetry of the patient must be closely

TABLE 6-9 Safety Requirements in Using a Speaking Valve

Type of Tracheostomy Tube Requirement
Traditional Cuff must be deflated.

Fenestrated Fenestrations must be opened by:
removing the nonfenestrated inner
cannula, or using a fenestrated inner
cannula.
Cuff may be inflated only when
fenestrations are open.
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