How to Use a Speaking Valve

Speaking valves are devices that restore the dignity of spoken communication to some individuals forced to use tracheostomy tubes. A health care professional, trained family member or the individual herself can attach the speaking valve to the tracheostomy tube, but there are some procedures that only a respiratory technician should undertake. The speaking valve opens whenever the individual inhales. When she exhales, the valve closes and air is forced up through the vocal folds, allowing speech. The air goes out through the mouth or nose. Younger individuals seem to adjust to the speaking valve quickly, but older patients may need to gradually increase the amount of time wearing the speaking valve until they are comfortable with it.

Things You'll Need

• Tracheostomy speaking valve, cleaned and dried
• Suction equipment
• Resuscitation bag including mask and reservoir
• Tracheostomy care equipment
• Extra tracheostomy tube

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Instructions

• 1

  Suction the trachea, then the mouth, to clean secretions from the airway. Very thick or profuse secretions may preclude use of a speaking valve. Unlike other devices, Portex brand tracheostomy tubes use an inner cannula that must be removed before inserting a speaking valve.

• 2

  Test your oxygen saturation level. It should be above 92 percent. Do not place the speaking valve when saturation levels are at or below 92 percent.

• 3

  Suction the mouth and nose with a tracheostomy tube cuff. Deflate the cuff. Re-suction the trachea and mouth after the tracheostomy tube cuff is deflated.

• 4

  Hold the tracheostomy tube neck plate of non-ventilator-dependent individuals with your non-dominant hand to stabilize it. Use your dominant hand to place the speaking valve in the tracheostomy tube without forcing it. Forcing the speaking valve into the tube may cause difficulty when removing it and damage the speaking valve’s diaphragm.

• 5

  Turn the speaking valve of non-ventilator-dependent individuals clockwise one-quarter turn. Place the tracheostomy tube cuff over the speaking valve for patients receiving supplemental oxygen.

• 6

  Adjust the ventilator and alarms for ventilator-dependent individuals. This must be done by a respiratory therapist.

• 7

  Insert the speaking valve between the flexible tubing and the swivel adapter of the ventilator circuit for ventilator-dependent individuals. Put the individual back on the ventilator. The ventilator’s pressure alarm will be on and the volume alarm off.

• 8

  Check to make sure the speaking valve is properly adjusted. Remove the speaking valve immediately when there are any signs of respiratory distress. For ventilator-dependent individuals, call the respiratory therapist to readjust the ventilator. Individuals with thick secretions may need an adjustment in the heat moisture exchanger.

• 9

  Encourage the individual to speak with the inserted speaking valve the same way she spoke before the tracheostomy. She may experience some coughing as her respiratory system begins working more normally. Those who haven't spoken for a prolonged period of time may need to work with a speech-language pathologist to relearn speech and breathing patterns required for speaking.

• 10

  Adjust the ventilator, if needed, if ventilator-dependent individuals find the feeling of continuous air flowing through the upper airway disconcerting or uncomfortable. The adjustments should be performed by a respiratory therapist.

• 11

  Remove the valve by first stabilizing the tracheostomy tube neck plate of non-ventilator dependent individuals with your non-dominant hand. With your other hand, carefully turn the speaking valve counterclockwise and remove it. Replace the inner cannula if using a Portex tracheostomy tube. For ventilator-dependent individuals, call the respiratory therapist to adjust the ventilator before removing the speaking valve. Remove the speaking valve, place the individual back on the ventilator and inflate the tracheostomy tube cuff.

• 12

  Follow the schedule in the individual's chart that determines when the tube should be worn. The chart will also note whether the speaking valve may be worn during meal times. Remove the speaking valve for suctioning, respiratory treatments and during sleep.

• 13

  Clean the speaking valve daily by swishing it in a cup of tepid water. Discard the water and refill the cup with tepid water with one drop of a non-fragrance dishwashing liquid added to it. Swish the speaking valve in the soapy water. Discard the soapy water, fill the cup with warm water, thoroughly rinse the valve with the water and let the speaking valve air-dry before placing it in its storage case.