Dysphagia Final

Front 1

Tracheotomy Definition

Back 1

 A surgical procedure used to secure an airway for respiration
 The trach tube is placed through an incision in the neck between the 2nd and 3rd tracheal rings

Front 2

Cricothyroidotomy

Back 2

 An incision is made in in the skin under the thyroid notch and through the cricothyroid membrane for placement of the trach tube.
 This tethers the larynx and causes poor laryngeal elevation

Front 3

Parts of a Tracheotomy Tube

Back 3

 Trach tube face plate
 Outer cannula
 Inner cannula
 Trach cuff
 Pilot balloon
 Fenestration

Front 4

Passy-Muir Speaking Valve

Back 4

 A one-way valve with a silastic membrane that is closed.
 Opens upon inspiration and closes when inspiration ends
 Pulmonary air is then directed around and through the trach tube (if fenestrated) to virabrate the vocal cords.

Front 5

Montgomery Valve

Back 5

 A silicone membrane is open at rest
 Opens more during inspiration
 Closes upon expiration
 Has a cough release feature

Front 6

Before the Swallow Study in a Trached Patient

Back 6

 Patient should be off the ventilator (although with spinal cord injuries, this may not be possible)
 Patient should be able tolerate cuff deflation
 Preferable for the patient to be able to use a speaking valve or trach capping to allow for subglottic pressure (protective cough and throat clear)
 Patient should be able to demonstrate a dry swallow and handle his/her own secretions

Front 7

Blue-Dye Swallow Study

Back 7

 All food and liquid textures are infused with blue food coloring
 PO trials are done the same as with the regular clinical swallow study.
 After each consistency, the patient is suctioned from the trach or asked to cough and the secretions are inspected for any blue-tinged material
 Many false negatives, but no false positives
 A negative Blue-Dye Study is usually followed by an instrumental examination at the SF VAMC
 Some institutions are more conservative and some are more liberal

Front 8

Advantages of Blue Dye Swallow Study

Back 8

 Can confirm the presence of gross aspiration when blue-tinged material is observed
 If aspiration is observed, it can be helpful when correlating the clinical signs of aspiration.

Front 9

Disadvantages of Blue Dye Swallow Study

Back 9

 Many false negatives
 Low sensitivity for trace aspiration
 All foods/liquids are dyed with BLUE food coloring
 Facilities have banned the use of blue food coloring.