This site uses cookies to store information on your computer. I'm fine with this Cookie information
Follow is on Twitter Like us on Facebook Follow us on Instagram
Covid-19 (Coronavirus)

Information and guidance for public, NHSGGC staff, and community-based services.  Hospital visiting restrictions now in place.

Communication

Return to list of contents

next

Speaking valves and decannulation caps must be removed at night or when patients are sleeping as valve malfunction may not be detected.

  • Finger Occlusion directly to the tracheostomy tube
    • This involves covering the tube on exhalation and encouraging the patient to vocalise. Where possible the patient should be instructed in self-occlusion
  • Speaking Valve
    • The function of a one way speaking valve is to redirect airflow on expiration. Air enters the tracheostomy tube on inspiration. On expiration the valve closes so that the air is redirected upwards through the vocal cords. The valves are fitted to the hub of the tracheostomy tube and eliminate the need for intermittent finger occlusion to vocalise.
    • Passy-muir valves are speaking valves designed for use in patients requiring positive pressure ventilation to allow vocalisation. Please refer to local policies on use.
  • Decannulation Cap
    • The function of the decannulation cap is to completely obstruct, inspired and expired airflow via the tracheostomy tube and allow the patient to breathe around the tracheostomy and via the fenestration. This should only be used under the direction of a competent healthcare practitioner.
  • Vocalising HME Device
    • This allows intermittent finger occlusion of the HME device which then acts as a speaking valve.

The tracheostomy tube must not be occluded unless the cuff is fully deflated

Means of Occlusion

  • Cuff deflation (see section on cuff deflation)
  • Fenestrated tracheostomy tube (see section on types of tracheostomy tube)
  • Use of a smaller tracheostomy tube (please note that by reducing the size of the tracheostomy tube the workload of breathing may be increased and the size of suction catheter that can be passed via the tracheostomy tube will be decreased)

Voice production may be achieved in patients with a tracheostomy tube by using one of the following 

Manipulation of the Tracheostomy Tube for Communicaiton 

  • Exaggerate normal articulatory movements
  • Decrease speech rate
  • Utilise short, simple phrases
  • Avoid complex words
Mouthing, encourage the patient to Oral Option -

These fall into 2 main categories – Oral and Non-Oral communication. Oral communication is the preferred method as this most closely mirrors normal communication.

Communication options

  • Sensory status (vision, hearing, touch)
  • Physical status (ability to sit up, use upper limbs to point, writing skills)
  • Oromotor abilities (mouthing)
  • 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:

  • Upper airway obstruction
  • Inability to tolerate cuff deflation
  • Patient requires ≥ 40% oxygen
  • Laryngectomy
  • Severe anxiety
  • Presence of upper airway oedema/trauma
  • End stage pulmonary disease
  • Reduced ability to clear secretions effectively
  • Haemodynamic instability
Valves may be less useful if there is a significant cognitive impairment or oromotor speech problems such as anarthria but their use should still be considered.  Remove the speaking valve/decannulation cap if any of the following are present
  • Respiratory distress
  • Increased respiratory rate
  • Tachycardia
  • Deterioration in oxygenation
  • Hypotension
  • Reduced consciousness
  • Increasing MEWS/SEWS
  • Difficulty in removing secretions
  • Patient complaining of breathlessness
  • Ongoing concern

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 Options

Glasgow 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.

  • Coded eye blinking (one blink for YES and two blinks for NO) 
  • Electronic communication systems (available from Speech and Language Therapy)
  • Handwriting – magic slates etc
  • Alphabet, picture boards, eye pointing charts