(0253) Speaking Valve Safety: Tracking Adverse Events When Speaking Valves Are Placed on Cuffed Tracheostomies

Introduction: Speaking valves (SV) provide patients with tracheostomy tubes (TT) the ability to communicate, but when placed on patients with inflated or improperly deflated cuffed TT there is risk of asphyxiation and death. Previous studies have elucidated the benefits of SV placement on ventilated patients with cuffed TT in the ICU, however there is limited information on the safety of SV placement on cuffed TT and the rates of inpatient adverse events related to this in non-ICU settings.

Methods: A retrospective chart review was conducted on patients with SV evaluation after tracheostomy placement at our tertiary care academic medical center between 2018-2022. A total of 238 patients received tracheostomies and 146 of those had a SV evaluation. Ultimately, 121 SVs were placed on cuffed TT and 25 were placed on uncuffed TT. Charts were reviewed for adverse events, including tracheostomy cuff inflation or TT dislodgement while a SV was in place.

Results: Of the 146 patients analyzed, no patients had an adverse even while the SV was in place. A total of 25 recorded adverse events including self-decannulation, false passage, desaturation, arrythmias, and altered mental status, but none occurred while the SV was on the tracheostomy. On qualitative analysis of SLP notes, instructions to not inflate the cuff with the SV in place and to only use SVs with direct supervision improves safe use.

Conclusions: Patients with cuffed TT can undergo SV placement with safety measures in place, even in a non-ICU setting. We provide educational supplements that demonstrate safe SV use that can improve patient communication and facilitate decannulation.