Tracheostomy Plugging

Tracheostomy Tubes - One-Way Valve and Cap Assessment (Policy #12055)

Lippincott Procedure:

Critical Note:

  • Speech-language Pathologist can conduct patient tolerance trials with both the Passy-Muir Tracheostomy and Ventilator Speaking Valve (PMV Valve) and the “Red Capped” Tracheostomy Plug, with a physician’s order.
  • The Speech-language Pathologist will notify the Respiratory Therapist when the PMV or Cap is placed and removed.
  • A Respiratory Care Practitioner or Physician must be present if the procedure involves initial cuff deflation, to perform tracheal and oral suctioning, to clear the airway of pooled secretions that could leak past the cuff, after the cuff is deflated, increasing the patient's risk for Ventilator Associated Pneumonia (VAP.)
  • While on a PMV Valve, “Capped” or on a Trach Mist, a patient’s airway must be assessed every four hours by the Respiratory Therapist AND, alternating, every four hours assessment by nursing, resulting in the patient’s airway being assessed every two hours. The RT or RN must remove the Valve or Cap and check for back pressure, secretions and patency.
  • The trachobturator must be taped at the head of the patient’s bed, and a handheld resuscitation bag, replacement trach tube, suction setup and pulse oximeter must be kept in each tracheostomy patient’s room. For isolation patients the replacement trach tube should be kept in the patient’s isolation cart and not at the bedside.
  • The cuff on a cuffed tracheostomy tube must remain fully deflated on patients not in the ICU, unless ordered by a physician. (For example, partial inflation to prevent aspiration.)

Procedure

  • Although an O2 adapter is available for Oxygen administration with the PMV Valve as stated, a venturitrach mist and trach collar are the preferred method of providing both oxygen and humidity to CMC trach patients both on and off a PMV Valve.

Trach Capping/Plugging:

  • NOTE: A handheld resuscitation bag or ventilator circuit cannot be connected to a trach patient without an inner cannula.
  • The inner cannula must be removed to insert the Red Cap. The inner cannula should be cleaned and retained for short trials. A new inner cannula should be obtained and kept at bedside for trials longer than 24 hours.
  • Capped patients are placed on a nasal cannula if supplemental oxygen is needed, since the Red Cap prevents the trach from being used as an airway.