Speaking valves and decannulation caps must be removed at night or when patients are sleeping as valve malfunction may not be detected.
The tracheostomy tube must not be occluded unless the cuff is fully deflated
Means of Occlusion
Voice production may be achieved in patients with a tracheostomy tube by using one of the following
Manipulation of the Tracheostomy Tube for Communicaiton
These fall into 2 main categories – Oral and Non-Oral communication. Oral communication is the preferred method as this most closely mirrors normal communication.
Ability to utilise facial expression (smiling, blinking etc)
For a patient with a tracheostomy consider the following areas to assist in determining the best communication option:
Nursing and medical staff have a key role in the care of patients with communication difficulties. It is important that all staff involved with the patient are aware of the preferred method.The impact of the loss of normal communication or voice following tracheostomy should not be underestimated and wherever possible patients and their families should be informed before the tracheostomy procedure that the patient is likely to experience some difficulty creating voice while the tracheostomy tube is in place. Patients should be reassured that it is expected that their voice will return once the tube is removed or modified as suggested below (except when a laryngectomy has been performed).
The above picture shows the airflow in a patient who has a speaking valve (or decannulation cap) attached to an unfenestrated tracheostomy tube with the cuff inflated. This patient is unable to breathe out and is therefore at high risk of hypoxia, pneumothorax and cardiac arrest
The above picture shows the airflow in a patient who has a speaking valve attached to an fenestrated tracheostomy tube with the cuff deflated. As can been seen, the patient is able to breathe out via the upper airway.
Contraindications for speaking vavle/decannulation cap/finger occlusion include:
Oxygen therapy and humidification should be administered as directed. It is possible to use a speaking valve with a suitable tracheostomy oxygen mask.
Click here for instructions on use of seaking valves
Click here of instrucitons on use of decannulation caps
Also see section on weaing from trachesotomy tube
Non Oral OptionsGlasgow Royal Infirmary Extention: 0141 211 (2)4819 Western Infirmary Extention: 0141 211 (5)2215 Stobhill Hospital Extention: 0141 201 (1)3715 Gartnavel General Hospital Extention: 0141 211 (5)3027 Southern General Hospital Extention: 0141 201 (6)1441 Victoria Infirmary Extention: 0141 201 (6)5949 Canniesburn Unit Extention: 0141 211 (2)5774 Royal Alexandra Hospital Extention: (4)6117 Inverclyde Royal Hosptial Extention: (6)4366 Beatson WOS Cancer Center Extention: 0141 211 (5)7007
If communication is particularly difficult please contact the Speech and Language Therapy Department.