PASSY-MUIR SPEAKING VALVE (PMV) ASSESSMENT

I. GENERAL PATIENT INFORMATION

Primary Ox
Intubation
Date performed
_ yes
Emergency
no
Oral Nasal
Comments:

Airway Related Ox
Extubation
Date performed
length of Intubation

Tracheotomll
Date performed
_surgical _ percutaneous

II. BESIDE ASSESSMENT

Vital Signs Stable
Yes
No
If no, explain

Steroids:

Tracheostomll Tube
Type
Size
Cuffed vs. Cuffless
Infiated Deflated
Inhaled
POIIV Reason

Secretions
Oral
Amount
Consistency
Color

Tracheal
Amount
Consistency
Color

Ventilator Settings

AlC rate

Ventilator Weaning
Trach Collar
SIMV/PS
Start Date
Schedule
Progress on Trach Collar Trials:

Tidal Vol
FI02
SpontVol
PEEP/CPAP
Compliance
Airway Resist

SIMV rate
PS
Pro Control
PIP
PalvD

Progress on SIMV/PS:

Nutritional Status
NPO
Oral (Diet level)
Food Consistency
Tube Feeding
Comments:

Swallowing Status
Clears secretions
- Yes
HiStory of aspiration
Yes
History of reflux problems _Yes
Bedside Swallow
_Passed
3 phase esophagram
Passed

Stomach

Small Bowel

No
No
No
Failed
Failed

Cognltive-Communicatlon Status
_Alert
Comments

Oriented

Disoriented

_ Nonresponsive

Mouthing Words

Air Flow I Cuff Leak

Cuff deflation (vent patient):
#Cc air removed from cuff (vent)
_ Oral leak observed (cough, voice, secretions)

Finger Occlusion (non-vent):

Stridor:
_Yes
Exhalation:
_PaSSive

32

No
Forced

III. PMV PLACEMENT DATA

Date

Time of Day

02 SAT IHR

Resp Rate

Accessory Muscles
Yes
No

Cough
_Strong
Guarded
Weak

Clears Secretions
_Yes
No

Anxiety
- Yes
No
Explain:

Vocal Intensity
_Strong
Weak

Speech
_ Intelligible
_ Unintelligible
Aphasic

Vocal Quality
_Whispery
Clear
Raspv

Back Pressure air

release on removal
Yes
No

Comments (including limitations to use):

PMV not appropriate, reason

Follow-up Recommendations (mark all that apply and describe reason):

DENT Consult:
o Trach Downsizing:
o Reassess In 24-48 hours
o Other:
Goals for PMV Use:

o Communciation
o Swallowing

o Airway Strengthening
o Cognitive Reorientation

o Secretion Management
o End of Life Issues

Reassessment (Attach a Progress Notes sheet for additional comments):

Date

Signature

Date

33

S';gnature