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[Dysphagia] trach button
If the button you're talking about is a cap, it is different from a
speech valve like the PMV. The PMV lets air in through the trach, but
not out. If the MD/pulmonologist thought the pt no longer needed the
trach, s/he probably thought the stoma would heal, but it would be
better for you to not count on that. A cap like the one you're talking
about would be an MD's call anyway. You could, if the MD gives the OK,
occlude the trach tube and watch a pulse ox to see whether there's any
change in saturation levels or the patient's comfort level.
If the RT thinks the cap is a good idea, my bet is that he's right, but
you still need to run it by the MD. Maybe the MD is too busy to have
thought of it. Where I work, the ST would just write his request on the
physician's order form. If the MD thinks it's a good idea, the nurse
gets the OK to document the request as a phone order.
Although the PM people have looked into this and published some
information on the topic, I haven't seen much other support for the
notion that a speech valve improves swallowing skills in trach patients.
Good luck!
On Thu, 16 Sep 2004 10:38:02 -0400, "Balch, Lucy"
<Lucy.Balch@hdmc.dmhmrsas.virginia.gov> said:
> 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
>
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