Trachi-Naze

Trachi-Naze Hands Free Valves — HFV Troubleshooting Chart

Problem	Possible Cause	Action
Poor seal on baseplate/or stoma stud being blown out	Poor application technique Hypertonic neoglottis High Intratracheal pressure Trying to speak too loudly (making too much effort) Failure to remove valve during coughing	Review application technique Secondary myotomy Check pressure and use as visual feedback to try and lower pressure Practice talking more softly Ensure correct use of valve Support baseplate during coughing
Air leakage around stoma stud	Check for correct size of stud Shape of stoma	Possibly increase stud size whilst using HFV Try Kapigel (with long stud only)
Shortness of breath	Green/blue filter insitu Too high resistance with valve Obstruction with mucous Acclimatisation to new product / new Trachi-naze user	Ensure use of orange filter with HFV Check valve sensitivity. Turning valve anti-clockwise will open valve and reduce resistance Try Valve B which has less resistance Ensure changing of filters if contaminated with mucous Check for chest infection and possibly discontinue use of HFV until resolved Establish tolerance of filters prior to progressing to Hands Free speech
Confusing hands free speech and oesophageal speech	Patient used to using oesophageal speech when not finger occluding	Focus on abdominal breathing Start voicing on a vowel or “h” to avoid air injection or inhalation
No voice	No seal on baseplate Poor fitting stoma stud	Check solutions as for problem  “no seal” Review sizing. Assess voice with baseplate and valve insitu to assess for this If good seal around stud, may need short length instead of long (less distance to valve to close off)
Weak or whispery voice	Hypotonic neoglottis Not enough pressure/lung volume to close valve	Try speaking in softer, lower pitch Try change in head position Consider pressure band Adjust sensitivity of HFV (turn clockwise to increase sensitivity and make speech easier May not be candidate for HFV if poor respiratory status
Valve closing too easily during normal breathing	Valve diaphragm has become worn over time Incorrect valve choice according to lung volume Incorrect sensitivity setting	Replace valve Try Valve Type B Adjust sensitivity
Air leakage between stoma stud & hands free valve	Stoma Stud has loosened with use	Replace stoma stud
Sore stoma and/or slight bleeding	Intolerance to increased pressure at stoma Stoma stud too large	Allow stoma to heal Assess for correct size Build up tolerance of valve over time
Valve coming off filter or occlusion cap with speech	Possible wear and tear to valve over time	Check how long valve been used for and how often taken on and off- replace valve

Although patients' may have good voicing with finger occlusion, when changing to hands free speech, it is not just a case of attaching a tracheostoma valve and carrying on as usual. Due to a "mechanical" device being in place, speech therapy will usually be required to achieve results that the patient will be happy with. This is as long as they have been assessed correctly and are possible candidates for hands free speech. Not all patients' are.

The patient may have to be taught:

• Improved breathing techniques
• Better controls of sentences i.e. correct length of sentence within 1 breath, where to stop and breathe etc.
• Possibly adjusting effort used in speech to maintain an adequate pressure for both baseplate seal and/or good voice
• Changes in pitch etc for improved voice quality
• Relaxation techniques

Any predisposing problems may be accentuated when hands free speech is tried.

• Trachi-naze Troubleshooting Chart →
  Click to download file: “Trachi-Naze_System_Troubleshooting_Chart.pdf”

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