Tracheostomy Management: Clinical Guideline: 2017

Barry, C., Downes, S., et al. (2017).

Dublin (Ireland): Irish Association of Speech and Language Therapists, 1-145.

<div>This clinical practice guideline provides recommendations for speech language pathology (SLP) management of tracheostomy in newborns, children, and adults.&nbsp;</div>

Irish Association of Speech and Language Therapists

<div>Individuals with tracheostomy should be receive assessment and treatment from multidisciplinary care teams (Level III Evidence).&nbsp;</div>

<div>This guideline reported the following recommendations regarding communication in individuals with tracheostomy:</div> <div> <ul> <li>Speaking valve trials should be conducted in adults without contraindications (Level IV Evidence).</li> <li>With multidisciplinary team agreement, leak speech or in-line speaking valves should be considered for medically stable, ventilated individuals without contraindications (Level III Evidence).</li> <li>Specialized, speaking tracheostomy tubes should be considered for voicing if cuff deflation during mechanical ventilation is not possible and prolonged ventilation is anticipated (Level III Evidence).&nbsp;</li> <li>Speaking valve assessment should occur for medically stable children with tracheostomy if they have suitable anatomical structure and airway patency (Level IV Evidence).&nbsp;</li> <li>In the event of unsuccessful speaking valve attempts with children, tracheal pressure should be assessed. Modification of the speaking valve (i.e., drilling a 1/16 inch hold in the plastic distal to the valve membrane) may be considered by the multidisciplinary care team (Level IV Evidence).</li> <li>Assessment of communication should be conducted as soon as possible in children with tracheostomy. This should include assessments of parent-child interaction, infant cues, verbal and gestural skills, and potential for augmentative and alternative communication&nbsp;(Level IV Evidence).&nbsp;</li> <li>Individualized management plan should be made to reduce the impacts of the tracheostomy on communication development in infants and young children (Level IV Evidence).&nbsp;</li> </ul> </div>

<div>This guideline reported the following recommendations regarding swallowing in individuals with tracheostomy:</div> <div> <ul> <li>SLPs should conduct clinical swallowing evaluations for adults with tracheostomy at risk of dysphagia (GPP-C).</li> <li>Instrumental swallowing evaluation should be conducted, if possible, in individuals with tracheostomy at risk of dysphagia (Level III Evidence).&nbsp;</li> <li>Consider the use of speaking valves during swallowing assessment, if clinically indicated (Level III Evidence).</li> <li>The blue dye test may be considered as an adjunct to swallow assessment in individuals with tracheostomy. This may be used to detect greater than trace aspiration, if medically suitable (Level IV Evidence).&nbsp;</li> <li>Clinical feeding evaluation, supported by instrumental studies, should be conducted for children with tracheostomy. These evaluations should be conducted as soon as medically indicated in order to determine safety for oral intake and appropriate management plans (Level IV Evidence).&nbsp;</li> </ul> </div>

<div>Tracheal suctioning is extended scope of practice for SLPs. It is not appropriate for SLPs to perform this task unless further competency training is undertaken (GPP-C).</div>