Initiating In-Line Ventilator Speaking Valve Protocols: Why & How? Kristin C. Dolan; CCC-SLP Kindred Hospital Melbourne, FL
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1 Initiating In-Line Ventilator Speaking Valve Protocols: Why & How? Kristin C. Dolan; CCC-SLP Kindred Hospital Melbourne, FL
2 Disclosure of Relevant Financial Relationships Passy-Muir, Inc consultant
3 Expected Outcomes: describe contraindications & benefits for candidacy to use in-line speaking valves. explain how to troubleshoot effective use of in-line speaking valves. discuss effective written procedures and protocols needed for safe in-line speaking valve use.
4 Quality of Life is PRICELESS SLPs are PIVOTAL to advocate for early PMV use with ventilated patients SLPs must work with the patient AND multidisciplinary members for success Problem solving is paramount A policy/procedure/protocol will provide safe decision making with objective criteria
5 Implementing CHANGE is NEVER easy! RESISTANCE is INEVITABLE! But resistance can be overcome by education and emphasizing the BENEFITS
6 WHY?
7
8 Complications of Tracheostomy and inflated trach cuffs: Tethers the larynx Reduces laryngeal elevation for epiglottic movement Reduces laryngeal protraction for UES relaxation Cuff overinflation trauma/complications
9 Complications of Tracheostomy and inflated trach cuffs: Lack of upper airflow No vocal production/communication Decreased oropharyngeal sensation Decreased sense of smell and taste Absent cough/throat clear effectiveness
10 Complications of Tracheostomy and inflated trach cuffs: Reduced subglottic air pressure Loss of PEEP Inability of Valsalva Reduced swallowing efficiency Poor TVC closure
11 All Passy-Muir Valves (PMVs) offer the benefits of the patented, closed position "No Leak" design that restores (or mimics) a closed respiratory system for normal upper aerodigestive physiology.
12 Clinical and Physiological Benefits of PMV placement Releases laryngeal tether for musculature mobility Restores voicing/communication Restores smell/taste Improves swallow, decreases aspiration risk Restores Subglottic pressures for coughing Improves TVC closure Restores upper airway sensation Dettebach, 1995; Stachler, 1996; Elpern, 2000; Suiter, 2003; Gross, 2003; Byrick, 1993
13 Clinical and Physiological Benefits of PMV placement Restoration of PEEP Alveolar recruitment to minimize atelectasis Increased gas exchange Improved saturation levels Frey & Wood; 1995
14 Clinical and Physiological Benefits of PMV placement Expedites ventilator weaning and decannulation time Rehabilitation of respiratory musculature Rehabilitation of the yucky muscles Increased confidence and motivation Frey & Wood, 1991; Sierros, 2007; Light, 1989
15 HOW?
16 YOU can be the CHAMPION What are your current methods/procedures? Are you only using PMV after weaning? What is your support staff knowledge? Are physicians aware of vent placement? Do you have protocols? Written guidelines, criteria, competencies
17 Support Staff RN RT MD DIETARY PMV PATIENT SLP OT PT Rehab
18 Use of the PMV requires a physician order. MD PMV PATIENT SLP
19 Cross-Train and Co-Treat RT RT Role SLP Role - Trach type/size - Voice - Cuff status - Speech/Language - Pressures/volumes - Cognition - Vital Signs - Swallowing - Vent/Alarm Adjustments - Vital Signs PMV PATIENT SLP
20 Improve rehab potential returning subglottic & intrathoracic pressure coordination balance valsalva PMV PATIENT OT PT
21 RT DIETARY Support Staff: RN PMV PATIENT Improve nutrition with return of smell/taste. Reduced need of deep suctioning with return cough. Orientation & cognitive nursing assessments
22 So. Who is your perfect patient?
23 Set yourself up for success! The perfect patient is. Alert Writing notes Tapping bed railing click-click Initially target a single set of patients and slowly expand.
24 Overview: Initial evaluation goals Tolerance of cuff deflation Baseline communication Trial PMV if indicated Troubleshoot trach tube type and size for PMV effectiveness Swallow status/aspiration risk
25 Overview: Stable criteria: STOP criteria: Oxygen guidelines FiO2 < 0.60 PEEP requirements < 10cm H2O Peak Inspiratory Pressure < 40cm H2O Cardiac guidelines: HR > 20bpm from baseline RR >35 Oxygen guidelines: FiO SpO2 < 0.90
26 Step One Tracheostomy Cuff Deflation Slowly May take several sessions to achieve full cuff deflation Assess airway patency/upper airway redirection of airflow Assess secretion management
27 Step Two PMV placement Ease of breathing Quality? Wheeze/WOB Reflexive/voluntary cough Secretion management Sustained phonation/speaking Troubleshoot trach size
28 Step Three Advanced PMV Placement as tolerated Coordination of speech with vent Breath control Increase complexity of communication Standardized testing/swallowing
29 Advanced Steps Progress to vent weaning on Aerosol Trach Collar (ATC) Advanced PMV placement with direct trach Trach Capping Decannulation
30 Conclusions: Know the complications tracheostomy use and the benefits of inline speaking valve use Become the CHAMPION and recruit your team support for protocols & competencies EDUCATE Modify your plan
31 Questions???
32 Educational Opportunities WEBINARS or SELF STUDY COURSES Application of Passy-Muir Swallowing and Speaking Valves Interdisciplinary Trach Team: Where Do I Start? Interdisciplinary Decision-Making with Patients Requiring Tracheostomy and Mechanical Ventilation Ventilator Basics for the Non-Respiratory Therapist Ventilator Application of the Passy-Muir Valve Swallow Function: Passy-Muir Valve Use for Evaluation & Rehabilitation Swallowing Management of the Tracheostomized Adult Patient How you breathe matters: Swallowing Safely Aerodigestive and Respiratory Changes Post Tracheostomy: A Comprehensive Review Passy-Muir Inc. is an approved provider of continuing education through ASHA, AARC, the California Board of Registered Nursing, and the Canadian Society of Respiratory Therapists
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RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE
Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Pulmonary Function and
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I. Definition This procedure is done in order to establish access to the airway in order to assist ventilation by the use of either endotracheal tube (ET tube) and bag, ET tube and continuous positive
GE Healthcare. Centiva/5 Critical Care Ventilator. Meet a new level of expectations
GE Healthcare Centiva/5 Critical Care Ventilator Meet a new level of expectations Intergrating performance and value Marry form and function In an environment where time and space are tight, the design