How To Use A Speaking Valve For Tracheostomy

The purpose of a speaking valve for tracheostomy is to help your adult speech therapy patient talk.

Speaking valves can improve phonation and speech intelligibility (Whitmore & Townsend, 2020). Plus, they can improve swallowing, secretion management, and more.

You’ll need specialized training to use a speaking valve. But read this article to learn:

• Who is appropriate for a speaking valve
• What a speaking valve trial might look like

What Is A Speaking Valve For Tracheostomy?

A speaking valve is a plastic, cap-like piece of equipment that’s connected directly to the external part of a tracheostomy tube. When your patient exhales, the one-way speaking valve closes. This allows airflow for voice production.   

Not only can speaking valves help patients speak, but they can improve cough, swallow, respiratory secretion management, and the ability to smell and taste (Gentile et al, 2024; Passy-Muir, 2024). 

There’s also evidence that using a speaking valve can reduce the instances of aspiration (O’Connor, 2019). 

The PassyMuir® Valve (PMV) is a popular and well-regarded speaking valve for tracheostomy. The company also offers classes (some free!) that are eligible for ASHA CEUs.

When Is A Tracheostomy Patient Appropriate for Speaking Valve Trials?

Every setting will have its own procedure for how to clear tracheostomy patients for speaking valve trials.

Usually, the physician and/or ENT clears patients for trials. In some settings, a respiratory therapist or qualified speech-language pathologist can clear a patient.

Again, you’ll need to be properly trained before doing speaking valve trials with a patient on a tracheostomy.

Ask your employer how to get trained. They may have you shadow an experienced SLP, complete online training, etc.

A patient may be appropriate for speaking valve trials if they meet all of the following conditions:

• Alert and able to follow commands
• Meet the criteria specified by the valve manufacturer
• Able to safely tolerate cuff deflation
• Medically stable  (Bier et al., 2004)
• Can manage secretions

Contraindications for a speaking valve include patients with:

• Severe upper airway obstruction
• High aspiration risk
• Excessive secretions they can’t manage 
• Impaired cognition
• Inability to tolerate cuff deflation
• Severely medically fragile and/or medically unstable (Bier et al., 2004)

How to Complete Speaking Valve Trials

Start speaking valve trials only if your patient safely tolerates cuff deflation, they’ve been cleared for safety, and you’ve been appropriately trained to do so. 

Safety Reminders

• Always deflate the trach cuff (if they have one) before placing a valve
• Never use a Passy Muir Valve with a foam-filled, cuffed trach tube
• Monitor the patient’s vitals plus their breathing (your observations and their report) throughout trials 
• Make sure the patient’s airway is clear of secretions. Have suction handy
• Remove the valve immediately if the patient has difficulty breathing
• Never use a speaking valve while sleeping

Patient Comfort

Speaking valve trials can be scary, uncomfortable, and strange for your patients, made worse by the limited ability to talk. 

Explain what you’re going to do before you do it so your patient understands what’s happening. Educate about what to expect, such as coughing after placing the speaking valve.

Don’t rush. Take things one step at a time and explain what you’re doing. And involve loved ones so their focus can be on the joy of communicating (Kobak, n.d.)

Steps To Speaking Valve Trials

1. Position the patient in a comfortable, upright posture
2. Wash your hands with antibacterial soap and dry with a clean paper towel or electric dryer
3. Put on PPE (gloves, mask, eye protection)
4. Clear the airway of secretions. Suction the trach and mouth and have the patient blow their nose, as needed
5. Monitor the patient’s vitals. Provide breaks and oxygen as needed
6. Deflate the cuff if the patient has one. Continue to monitor vitals and breathing. Suction as needed
7. Hold the neck plate (flange) in place with one hand to avoid twisting the trach
8. Place the speaking valve. If using a Passy Muir Valve, place it on the tracheostomy tube opening and give a gentle, one-quarter turn to the right (clockwise). Encourage the patient to cough. Provide oral suction as needed.
9. Observe the patient closely for signs of distress, such as increased heart rate, discomfort, or work of breath. Reinflate the cuff and/or provide oxygen as needed.
10. Encourage the patient to vocalize. You may need to start with sustained phonation sounds, such as /ah/ then work up to words and beyond
11. Check their swallowing abilities with the speaking valve in place, if indicated
12. Gradually increase speaking valve wear time. Start with short intervals and gradually extend time.
13. Reinflate the cuff if a patient has one. Provide suction as needed
14. Assess vitals and breathing
15. Clean the speaking valve with warm water and a few drops of mild fragrance-free dish liquid. Don’t use peroxide, bleach, vinegar, alcohol, brushes, or cotton swabs to clean the speaking valve. Air dry only
16. Appropriately clean other equipment, complete hand hygiene, and provide patient education

More Resources

References

• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Passy Muir Valves – Passy-Muir
• Bier, Jacqueline APRN, MA; Hazarian, Leon RN, BSN; McCabe, Donna RN, GNP, MA; Perez, Yaquelin RN, BSN. Giving your patient a voice with a tracheostomy speaking valve. Nursing 34():p 16-18, October 2004. 
• Gentile MN, Irvine AD, King AM, et al. Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes. Tracheostomy. 2024;1(1):26-41.
• Kobak, J. (n.d.). Application of Passy Muir Swallowing and Speaking Valves. [Webinar]. Passy Muir.
• LaRoche, K. & Clinical Procedure Manual Review Board. (n.d.) Tracheostomy—Humidity Administration, Speaking Valve Placement and Removal, and Unplanned Tube Decannulation. [Online Course]. Medbridge.
• O’Connor, L. R., Morris, N. R., & Paratz, J. (2019). Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review. Heart & lung : the journal of critical care, 48(4), 356–364. https://doi.org/10.1016/j.hrtlng.2018.11.006
• Whitmore, K. A., Townsend, S. C., et al. (2020). Management of Tracheostomies in the Intensive Care Unit: A Scoping Review. BMJ Open Respiratory Research, 7(1).