[Dysphagia] trach button

[Lucy.Balch at hdmc.dmhmrsas.virginia.gov (Balch, Lucy)]

Does anyone have any experience with trach buttons? I have an adult MR pt.
who was given both trach and PEG tubes after a life threatening burn
accident in 4/00. After trials with plugging, his physician decannulated him
in Feb '03, but his stoma never closed. Prior to his accident he was
ambulatory and eating regular foods, but he has not eaten or walked since
the accident (he refuses PT). His swallowing ability was tested a few months
after decannulation and he proved to have unstable swallowing (intermittent
choking if his positioning was crooked at all, bolus was too large, etc),
probably d/t the open stoma/open respiratory system. He was seen by an ENT
who agreed to surgically close the stoma, but the pt.'s LAR did not agree to
the surgery. Mechanical closure with reinsertion of a trach tube with a PMV
has stabilized the swallow. However, wondering if a trach button would work
just as well. The RT where I work suggested it. I have never heard of one.
Would it close the respiratory system as well as the PMV does? Is it
something that can be maintained easily? The pt. is not yet off the G-tube,
but that is the goal. He currently eats lunches under supervision of OT or
ST, and does well with his PMV (no intermittent choking). I've been hesitant
to progress him further (more meals) because our nurses are unfamiliar with
the PMV and much training of staff is needed to keep him safe at meals.
Perhaps the button could simplify things and get him weaned faster/safer.

I'd appreciate any ideas, thoughts, information.

Thanks,

L Balch, SLP