Tracheostomy and Laryngectomy

Question 1

tracheostomy

Answer 1

• an opening created through the neck into the trachea
• alternative access to airway
• placement between 2nd and 3rd tracheal ring (midline)
• speech through speaking valve (more natural voice)
• changes are usually temporary

Question 2

laryngectomy

Answer 2

• surgical removal of larynx due to trauma/cancer
• partial or total removal
• speech is never “normal” again
• TEP or electrolarynx
• changes are permanent and irreversible

Question 3

tracheostomy: fenestrated

Answer 3

small hole to allow air to pass through tube to vocal folds

Question 4

tracheostomy: unfenestrated

Answer 4

• no small holes
• requires speaking valve for air to be passed to vocal folds

Question 5

tracheostomy: cuffed tube

Answer 5

• cuff at end of tube seals off upper airway
• airway is protected from aspiration
• if tube is blocked, no oxygen can get to the lungs

Question 6

tracheostomy: uncuffed tube

Answer 6

• no seal in the trachea
• air can flow through mouth and nose, through tube, and beyond
• airway is not protected from aspiration

Question 7

speaking valve

Answer 7

1. first, make sure the cuff is deflated!
2. next, place speaking valve directly on the trach tube
3. once respiration stable, assess if individual can phonate

Question 8

speaking valve: 1. first, make sure the cuff is deflated!

Answer 8

• most important step
• if speaking valve is placed on an inflated cuff individual will not be able to breathe!

Question 9

speaking valve: 2. next, place speaking valve directly on the trach tube

Answer 9

• monitor O2 stats and respiratory distress (i.e., drop in O2, noted discomfort, shortness of breath, etc.)
• if any signs/symptoms of respiratory distress, remove speaking valve immediately

Question 10

speaking valve: 3. once respiration is stable, assess if individual can phonate

Answer 10

• Passy-Muir
• Shiley Valve

Question 11

Passy-Muir

Answer 11

• most common speaking valve
• may be used both on and off ventilator

Question 12

Shiley Valve

Answer 12

for alert individuals who can breathe independently without mechanical ventilation

Question 13

dysphagia

Answer 13

• assess aspiration risk, typically very high risk
• blue dye test (varying evidence), suction trials

Question 14

decannulation

Answer 14

• SLP not involved in decannulation
• smaller tube, capping trials, and removal