Passy Muir ValveSpeaking Valve for Tracheostomy Patients

Deidre Dennison, RNVascular Intensive Care

How it Works Contraindications

Benefits

Initiation Making Connections

References

Indications

Invented in 1985 by David Muir – 23 year old quadriplegic with muscular dystrophyUnique, one-way speaking valve allows patients to inhale through the speaking valve “No leak” design prevents air from escaping through or around the valve Forces exhaled air up over the vocal cords and through the oronasopharynx Design allows a column of air to be trapped within the valve/tracheostomy space preventing secretions from moving into the tracheostomy and occluding the PMVAvailable for use in pediatric and adult patientsMay be applied directly to the tracheostomy with/without oxygen or in-line with the ventilator circuit

Inability to tolerate cuff deflation – cuff MUST be deflated

Severe airway obstruction

Medical/hemodynamic instability

Foam –filled cuffed tracheostomy tube

Severely non-compliant lungs

Unmanageable secretions

Endotracheal intubation

Not to be used while sleeping

Helps to restore more natural “closed respiratory system” Allows patients to regain the ability to communicate and participate more effectively in the plan of careImproves swallowRestores intrinsic PEEP (positive end expiratory pressure) facilitating better oxygenationReduces tracheal suctioning by assisting patients in developing a more effective coughAids in ventilator weaning by returning use of the diaphragm and respiratory muscles during exhalation and speakingAllows patients to regain strength & sensation in upper airwayBuilds confidence and improves quality of lifeFacilitates pediatric language developmentMay be used on and off the ventilator

Requires a multidisciplinary approach involving collaboration between the Speech-Language Pathologist, Physician, Respiratory Therapy, and the Registered Nurse

Initial assessment includes the patient’s ability to tolerate cuff deflation – the cuff must ALWAYS be deflated while using the Passy-Muir valve. Failure to do so will prevent inhaled air from being exhaled as it will not be able to pass through the upper airway or out of the tracheostomy tube

Quantity and quality of secretions should be considered as the patient will be learning to deal with them differently, for example during a respiratory infection, after mucolytics or after pulmonary tolieting

Assessment of airway patency and the patient ‘s ability to breathe around the tracheostomy tube and deflated cuff should be performed prior to placement of the Passy-Muir valve

Employed in a variety of settings including rehabilitation, sub-acute care, as well as intensive care; may be initiated as early as 72 hours post tracheostomy

Appropriate education for patients regarding change in airways pressure, sensation of upper airway, and change in secretion management should be performed in order to reduce patient anxiety

Quadriplegia

Mechanically ventilated/dependent patients

Tracheomalacia

Neuromuscular disorders

Head trauma

COPD

Mild tracheolaryngeal stenosis

Bedside assessment before, during, and after valve placement includes: changes in patient’s breathing pattern, work of breathing, oxygen saturation, heart rate, secretions, color & mental status, and patient reaction

Patient should be sitting in a semi-Fowler’s or Fowler’s position in order to maximize lung expansion and diaphramatic movement

Suctioning should be performed prior to valve placement as needed; suctioning while slowly deflating the tracheostomy cuff may help prevent pooled secretions from entering the lower airway

Off the ventilator, the PMV fits directly onto the tracheostomy tube hub; may also be used with humidified oxygen via a trach collar or an oxygen cannula via a PMV oxygen adapter

When used during mechanical ventilation the PMV 007 (Aqua) fits directly into the disposable ventilator tubing; other PMV models require non-disposable tubing

Requires ventilator alarm adjustments including low volume alarms as the patient is exhaling volumes through the upper airway instead of returning it to the ventilator

May be utilized with most conventional modes of ventilation including pressure control (PC), assist/control (AC), pressure support ventilation (PSV), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP)

Passy-Muir tracheostomy and ventilator speaking valve resource guide. Passy-Muir Inc., October 1997; revised March, 2003.

Hess, D. (2005). Facilitating speech in the patient with a tracheostomy. Respiratory Care, 50(4), 519-525.