[Dysphagia] trach button

[kbreese at stny.rr.com (kbreese)]

I think you are referring to what is called a "trach cap" in my neck of the 
woods - but the respiratory therapist should be able to define it better. 
I've seen them on patients who are almost ready to be decannulated, but not 
quite - so they are capped several hours per day - the trach tube is still 
there if needed, while they are learning to inhale/exhale on their own.  The 
PMV allows for inhalation through the valve/trach tube, then the one-way 
valve closes to allow the individual to exhale through the upper airway, 
allowing vocalization to occur as the expired air is allowed to pass over 
the vocal cords.  The Passy Muir company will send you a packet of 
information with a video that you may find helpful for the staff you 
mentioned.  Possibly a pulmonary doc could advise on the button/cap?  Good 
luck, Kathy
----- Original Message ----- 
From: "Balch, Lucy" <Lucy.Balch@hdmc.dmhmrsas.virginia.gov>
To: <dysphagia@b9.com>
Sent: Thursday, September 16, 2004 10:38 AM
Subject: [Dysphagia] trach button


> 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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