Speaking valves are placed on the end of the tracheostomy tube to allow speaking in patients with vocal function. The valve flap is attached to the valve housing in such a way that, during inspiration, it opens and air can stream in. During expiration and speaking, the flap is pressed against the valve housing by the expired airflow and closes the cannula opening, creating the seal required for speaking. It also facilitates improvements in voice, cough, smell, taste and secretion management.
Candidates for a speaking valve include adults with a tracheostomy (including mechanically ventilated patients) who are awake, relaxed, and responsive and assessment criteria of the physician.
Patients who aren't eligible for a speaking valve include those who have severe upper airway obstruction or aspiration risk, tenacious or copious secretions, decreased cognitive status, severe medical instability, or inability to tolerate cuff deflation. The speaking valve can't be used with other kinds of artificial airways, such as endotracheal tubes, or with foam-filled cuffed tracheostomy tubes, which must be plugged to keep the cuff from reinflating.
The patient should remove the valve while sleeping or sleepy.
It is important to maintain the speaking valve keeping it clean and clear and assess the patient's secretions often to avoid mucus plugs. It should be cleaned or as needed with warm water and mild, fragrance-free soap, rinsed thoroughly, air-dried, then repaces in its storage container.