Passy-Muir PMV 005 Mode D'emploi page 8

8. PMV Attachment: Stabilize the tracheostomy tube with one hand while attaching the
PMV to the 15mm hub of the tracheostomy tube with the other hand using an
approximate 1/4 twist. The PMV has a friction fit for secure placement.
CAUTION: Excessive force should not be used when placing the PMV 005 (White) on the
tracheostomy tube as it may obstruct movement of the PMV diaphragm.
9. Patient Monitoring and Removal of PMV: Observe patient to ensure that the
diaphragm of the PMV opens during patient's inspiration and remains closed during
exhalation. Observe the patient with the PMV in place to ensure the patient has adequate
airflow around the tracheostomy tube. If patient exhibits signs of respiratory distress,
remove PMV immediately and reassess for airway patency.
To remove PMV, stabilize the tracheostomy tube with one hand and twist the PMV off
gently with the other hand. If using a tracheostomy tube that has a hub that rotates, it
may be necessary to use a rocking rather than twisting motion to remove the PMV.
WARNING: IF THE PATIENT EXPERIENCES DIFFICULTY UTILIZING THE PMV, THE
PATIENT MAY HAVE AIRWAY OBSTRUCTION DUE TO STENOSIS, TISSUE MASS,
TRACHEOMALACIA, GRANULATION, VOCAL CORD PARALYSIS IN THE MIDLINE
POSITION, SECRETIONS, OR A TRACHEOSTOMY TUBE THAT IS OVERSIZED FOR
THE PATIENT'S TRACHEA. WITH CORRECTION OF THE OBSTRUCTION, THE
PATIENT SHOULD BE RE-EVALUATED FOR PMV USE.
10. Patient Transitioning: Many patients adjust immediately and easily to the PMV.
However, some patients may require a gradual transition to wearing the PMV. Some
patients can tolerate the PMV during all waking hours (e.g., 16-18 hours per day). Re-
education of breathing pattern and voice/speech production may be needed if the patient
has not vocalized for a prolonged period of time. A Speech-Language Pathologist can
assist in retraining. Patients will experience more normal respiratory sensations such
as airflow in the oral/nasal chambers, and the effects of increased respiratory muscle
activity. Patients may initially experience increased coughing due to restoration of a
closed respiratory system, which re-establishes subglottic pressure and normal exhaled
airflow in the oral/nasal chambers. Therefore, secretion management is facilitated
creating movement and clearing of tracheal secretions, which aids in pulmonary
hygiene. If patient exhibits prolonged excessive coughing, PMV should be removed
and airway patency should be reassessed.
PMV CONNECTIONS
Fenestrated Tracheostomy Tubes: The PMV can be used with fenestrated tracheostomy tubes
although a fenestrated tube is NOT required. If using an inner cannula to connect the PMV, it is
necessary that both the inner and outer cannula be fenestrated to take advantage of the fenestration.
If the fenestrated tube is cuffed, the cuff must be completely deflated. Using the PMV with a fenestrated
tube may offer the advantage of further improvement in speech volume along with the other benefits
of the PMV.
Inner Cannula: The PMV fits on the universal 15mm hub of adult, pediatric and neonatal
tracheostomy tubes with a friction fit. Some tracheostomy tube designs may provide the 15mm
hub as part of the inner cannula or the outer cannula. When using the PMV 005 (White) on
tracheostomy tubes that have a disposable inner cannula with grasp ring, it is necessary to ensure
that the grasp ring does not extend beyond the 15 mm hub of the tracheostomy tube. If it does
extend beyond the 15mm hub, the inner cannula should be removed prior to PMV 005 (White)
use. CAUTION: If the grasp ring on the inner cannula is sprung outward beyond the 15mm hub
it may obstruct movement of the PMV 005 (White) diaphragm.
Metal Tracheostomy Tubes: Some manufacturers of metal tracheostomy tubes (pediatric and
adult sizes) offer an optional inner cannula with a 15mm hub which will allow for connection of
the PMVs, as well as other respiratory equipment. The inner cannula with 15mm hub may be
ordered from the manufacturer or its distributor. A plastic endotracheal tube adapter may be
sized to a low-profile, metal tracheostomy tube to create a 15mm hub that will allow for placement
of the PMV.
Humidity: Humidity (non-medicated heated aerosol) can be applied at the tracheostomy tube
site with the PMV in place via the use of a trach collar or T-piece.
6