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Tracheostomy and a Passy-Muir valve

 
Child with Passy-Muir valve

We talk when air moves up from our lungs through our vocal cords. When your child has a tracheostomy (trach), most of the air goes past the vocal cords and out through the trach tube. This changes your child’s ability to talk. Some air might go up to the vocal cords. But it might not have enough force to make them move. Or, there might only be enough for very short sounds.

A Passy-Muir valve, or PMV, can help your child talk when he has a trach. The valve goes on the outside opening of the trach tube. It opens when your child breathes in, but closes when he breathes out. This pushes air around the trach tube and up through the vocal cords, so your child can make sounds.

How to use the Passy-Muir valve

  • Suction your child’s trach tube and mouth to remove extra mucus. Having a lot of mucus can cause breathing problems and might cause a lot of coughing. (See “Do You Know… How to Suction a Trach.”)
  • If the trach tube has a cuff, deflate it completely before you attach the PMV. If the cuff is inflated, it will block the airway space around your child’s trach tube. Then your child cannot breathe out through the mouth and nose.
Passy-Muir valve
  • Give your child a few minutes to rest after suctioning the trach and deflating the cuff.
  • Hold the flange of the trach tube with one (1) hand. The flange is the part that lies on your child’s neck that the ties are attached to.
  • Put the PMV over the end of the trach tube and twist it to the right (clockwise) about one-quarter of the way around. This keeps the valve from coming off when your child coughs. Do not pus hthe PMV onto the trach tube with force. This could make it hard to take off later.
  • Your child might cough when you put the PMV on. This happens because he is breathing out through his mouth instead of the trach tube. This can cause your child to feel mucus in his throat. If your child coughs hard enough to pop the PMV off, suction the trach and put the PMV on again.
  • Watch your child for breathing problems and changes in skin color. If your child’s pulse, temperature, or blood pressure goes below normal, take the PMV off right away. If the pulse, temperature, or blood pressure does not go back to normal right away, call your child’s doctor. (See “Do You Know…When to call 911 if your child has trach problems.”)
  • To remove the valve, hold the flange of the trach tube. Turn the PMV to the left (counter clockwise).

Ways to keep your child safe

  • The PMV must be completely clean and dry before placing it in the storage container. This keeps bacteria from growing. These are germs that could give your child an infection.
  • Deflate the trach tube cuff completely before using the PMV.
  • Your child should never wear the PMV while sleeping.
  • Take off your child’s PMV before giving medicated nebulizer (breathing) treatments.
  • Do not use the PMV with foam-filled, cuffed trach tubes.
  • Take the PMV off right away, if your child has trouble breathing.

What can I use with a Passy-Muir valve?

  • Your child can use oxygen with the PMV in place.
  • Humidity can be used with the PMV in place. However, use caution when using a trach humidity system. It might make less humidity because it needs air from the trach tube to pass through it. When your child wears a PMV, this air goes out through the mouth and nose instead of the humidity system.

Cleaning the Passy-Muir valve

Only one (1) patient should use a PMV. Do not share the PMV with another child or use another child’s PMV. Clean it after every time your child wears it.

How to clean a PMV

  • Swish the PMV in soapy, warm water (not hot water).
  • Rinse the PMV completely in warm running water.
  • Let the PMV dry completely in the air before putting it in the storage container or using it again. Do not use heat to dry it.
  • Do not use peroxide, bleach, vinegar, alcohol, brushes, or cotton swabs to clean the PMV.

How long does a Passy-Muir valve last?

Each PMV is guaranteed to last at least 2 months if you use and clean it properly. You can use it longer if it does not get sticky, noisy, vibrate, or cause breathing problems when your child breathes in.

Fixing problems with the Passy-Muir valve

Breathing problems

If your child has breathing problems with the PMV on the trach, follow these steps:

  • Check the position of the trach tube. Is it straight in the airway?
  • Check your child’s position. Have your child sit up straight to breathe better.
  • Make sure the trach cuff is completely deflated.
  • Suction the airway through the trach tube again, if needed.
  • If the mucus is thicker than usual, take off the PMV and call your child’s doctor.

If you do the steps above and your child still has trouble breathing, take the PMV off and talk to your child’s doctor or speech therapist.

PMV pops off

If the PMV pops off when your child coughs, follow these steps:

  • Check to see if the trach needs suctioning again.
  • If your child keeps coughing hard and cannot stop, take the PMV off right away. Suction your child’s trach if needed. This kind of coughing might mean something is blocking the airway.
  • If your child keeps coughing, you might need to replace the trach. (See “Do You Know … Changing a trach tube”).

If you do the steps above, and the PMV does not stay on, take it off. Talk to your child’s doctor or speech therapist.

Honking noise

If the PMV is making a “honking” noise, follow these steps.

  • If you have used the PMV longer than 2 months, this sound means that it is time to replace it.
  • If the PMV is newer than 2 months, clean it and let it air dry.

Eating with a trach

Having a trach does not usually affect eating or swallowing. But sometimes the trach position or the way that air flows can change how your child swallows. To help prevent swallowing problems, you can do the following:

  • Make sure your child is not lying too flat. The shoulders should be slightly raised.This lets the head and neck be slightly extended (stretched out, not pressed down). You can put a rolled towel or blanket under your child’s shoulders to raise them slightly.
  • Make sure your child’s head and neck are not extended (stretched) too much.
  • Make sure the trach cuff is not inflated, if your child’s trach has a cuff.

The Passy-Muir valve usually helps your child swallow. It lowers the risk of food and liquid getting in the lungs. Because the PMV helps air flow more naturally through the mouth, your child can feel food and liquid in the throat before it spills over into the lungs.

If your child eats by mouth, suction the trach tube before he eats. This can keep you from needing to suction during or after meals. Suctioning during and after meals can cause extra coughing, and this can cause vomiting. (See “Do You Know…How to suction a trach.”)

Patients with trachs often have thick mucus. Encourage your child to drink lots of fluids. This will help make the mucus thinner. It will be easier to for your child to cough up mucus and for you to suction the trach.

Signs of a swallowing problem

Always watch your child while he is eating to be sure food does not get into the trach. Watch for signs that could mean your child is having swallowing problems.

  • Hard time eating or refuses to eat
  • Choking or coughing when eating or drinking
  • Vomiting while eating or right after
  • Food in the trach mucus
  • Drooling a large amount, or much more than normal
  • Large amounts of watery mucus from the trach
  • Your child’s breathing sounds loud and “stuffed up,” or your child gets a lot of colds and other nose and throat infections
  • Your child does not notice having food in his mouth, or he notices it more than normal

Questions?

If you have questions about the Passy-Muir valve, talk to your child’s clinical nurse specialist or doctor. A nursing coordinator is always here to answer your questions and address your concerns. Call 901-595-3300 and ask for the nursing coordinator. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 when the call connects.


 

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).

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