Passy Muir® Speaking Valve

What is a Passy Muir Valve?

A Passy Muir^® Swallowing and Speaking Valve (PMV^®) is a medical device that helps someone with a tracheostomy (trach) speak and swallow more easily. The PMV goes on the outside opening of the trach tube. 

The PMV opens when your child breathes in and closes when they breathe out. This pushes air around the trach tube and up through the vocal cords, so your child can make sounds. 

A speech-language pathologist (SLP) will evaluate your child to see if they can benefit from a PMV. A PMV must be used under direct medical supervision until family caregivers have been trained to use and care for the valve. 

Always follow the specific instructions given by your care team.

How a Passy Muir Valve works

A tracheostomy is a surgery to make an opening in the trachea (windpipe). A tracheostomy tube (trach tube) is placed into the opening for breathing. 

We talk when air moves up from our lungs through our vocal cords. After a tracheostomy, most of the air your child breathes in and out goes directly through the trach tube. Air bypasses the larynx (voice box), throat, and nose. 

This changes your child’s ability to talk. Some air might go up to the vocal cords. But it might not have enough force to make them move. Or, there might only be enough for very short sounds. 

Because the air doesn’t pass through the vocal cords, your child may not be able to talk or make sounds unless a speaking valve is used. 

The PMV controls the direction of air flow. A PMV is a one-way valve so air can go in but not out. 

Benefits of a Passy Muir Valve 

A PMV can help your child:

• Talk, laugh, cry, and make other sounds
• Swallow more safely
• Develop their speech and language skills 
• Be able to smell and taste food and drinks better
• Cough and clear their throat 
• Improve lung function
• Have better emotional and social well-being 

If your child needs extra oxygen support, they can use oxygen with their PMV.

How to use a Passy Muir Valve 

Once your child can wear the PMV without the supervision of a speech-language pathologist (SLP), the SLP will teach family caregivers how to attach, use, and take care of the PMV. 

These steps are for family caregivers who have been cleared to use a PMV without direct medical supervision. Always follow the instructions given by your care team. 

Suction the trach tube

Before you attach the PMV, suction your child’s trach tube and mouth to remove extra secretions. Having a lot of secretions can cause breathing problems and coughing. 

Deflate the cuff on the trach tube (if it has one)

If your child’s trach tube has an inflatable cuff, deflate it completely before you attach the PMV. If the cuff is inflated while wearing a PMV, the cuff will block the airway space around your child’s trach tube so they cannot breathe out through the mouth and nose. 

Give your child a few minutes to rest after suctioning the trach and deflating the cuff before attaching the PMV.

Attach the Passy Muir Valve

• Hold the flange of the trach tube with 1 hand. The flange is the part of the trach tube that lies on your child’s neck that the ties are attached to.
• Put the PMV over the end of the trach tube and twist it to the right, about a one-quarter turn. This helps keep the valve from coming off when your child coughs. 
• Do not push the PMV onto the trach tube with force. This could make it hard to take off later. 

Your child might cough when you put the PMV on. This happens because air is now exiting their mouth instead of the trach tube. Your child can feel mucus and other secretions in the throat. 

If your child coughs hard enough to pop off the PMV, suction the trach and put the PMV on again.

Watch your child for breathing problems and changes in skin color. If your child’s pulse, temperature, or blood pressure goes above or below normal, take the PMV off right away. If the pulse, temperature, or blood pressure does not go back to normal right away, call your care team.  

To remove the valve, hold the flange of the trach tube. Turn the PMV to the left (counterclockwise).

How to clean the PMV

Clean the PMV after each use. To clean the PMV:

1. Put a few drops of mild dishwashing soap into a cup of warm water. Do not use hot water.
2. Wash the PMV in the warm, soapy water.
3. Rinse the PMV completely in warm running water.
4. Place the PMV on a paper towel and let it air dry completely. 

Make sure the PMV is completely dry before putting it in the storage container or using it again. Do not use heat to dry it.

Do not use peroxide, bleach, vinegar, alcohol, brushes, or cotton swabs to clean the PMV.

Each PMV should last at least 2 months if you use and care for it properly. You can use the PMV longer if it does not get sticky, noisy, vibrate, or cause breathing problems. 

How to fix Passy Muir Valve problems

Breathing problems

If your child has breathing problems with the PMV, follow these steps:

• Check the position of the trach tube. It should be straight in the airway.
• Check your child’s position. Have your child sit up straight to help them breathe better.
• If the trach cuff is inflatable, make sure the cuff is completely deflated.
• Take off the PMV and suction the trach if needed. If the mucus is thicker than usual, remove the PMV and call your care team. 

If you do the steps above and your child still has trouble breathing, take off the PMV and talk to your child’s care provider.

The PMV comes off

If the PMV comes off when your child coughs, follow these steps:

• Check to see if the trach tube needs suctioning and suction it if needed.
• Replace the PMV. 
• You may need to clean the PMV before putting it back on, or use a different PMV if it touched a dirty surface.

Contact your care team if the PMV does not stay on after following the steps above. 

Your child keeps coughing

• If your child keeps coughing and cannot stop, take off the PMV.
• Suction your child’s trach tube if needed. 
• If your child keeps coughing after suctioning, something may be blocking their airway. You may need to change the trach tube. 

Honking noise

• If the PMV is making a “honking” noise, and you have used the PMV longer than 2 months, this sound means that it is time to replace it.
• If the PMV is newer than 2 months, clean it and let it air dry.

How to eat and drink with a trach 

The trach position or the way that air flows with a trach can sometimes change how your child swallows. A PMV helps air flow more naturally through the mouth. This can help your child feel food and liquid in their throat before it accidentally enters the lungs.

To help prevent swallowing problems with a trach:

• Make sure your child has been cleared by a speech-language pathologist or other care provider to eat foods by mouth.
• Make sure your child is not lying flat when they eat or drink. Have your child sit upright or in a slightly reclined position. Your child’s head and neck should be in a neutral position. 
• If your child’s trach tube has an inflatable cuff, make sure it is completely deflated before eating. 
• Suction the trach tube before eating. This can prevent the need to suction during or after meals. Suctioning during and after meals can cause extra coughing, which can lead to vomiting. 
• If your child is cleared by your SLP to have liquids, encourage your child to drink lots of fluids to help thin mucus and secretions. It will be easier for your child to cough up mucus and for you to suction the trach.

Signs of a swallowing problem

Your child may have problems with swallowing with a trach tube. Always watch your child when they are eating to be sure food does not get into the trach. 

Watch for these signs of a swallowing problem: 

• Difficulty eating or refusing to eat
• Choking or coughing when eating or drinking
• Changes in oxygen, heart rate, or respiratory (breathing) rate
• Vomiting while eating or right after
• Food in the trach tube
• Drooling in large amounts or much more than normal
• Large amounts of watery mucus from the trach
• Breathing sounds loud and “stuffed up” 
• Not noticing food in their mouth

Safety reminders for a Passy Muir Valve 

• Do not use the PMV without direct medical supervision until you have been trained by your SLP.
• Clean and let the PMV air dry completely before storing. This keeps bacteria and other germs from growing. Some germs can make your child sick or cause an infection. 
• Deflate the trach tube cuff completely before using the PMV.
• Do not let your child wear the PMV while sleeping.
• Take off your child’s PMV before giving breathing treatments with a nebulizer. 
• Do not use the PMV with foam-filled, cuffed trach tubes.
• Take off the PMV right away, if your child has trouble breathing.
• Do not use a Heat and Moisture Exchanger (HME) with a PMV. 
• Use caution when using a trach humidity system with a PMV. The system may provide less humidity because air goes out through the mouth and nose instead of the trach tube. 
• Do not share the PMV with another child or use another child’s PMV. 

When to call your care team

Contact your care team if your child has any of the following:

• Mucus in the trach tube that is thicker than usual or has changes in color or odor
• Change in breathing, pulse, temperature, or blood pressure that does not go back to normal right away after taking off the PMV
• Coughing that does not stop 
• PMV won’t stay on

Call 911 and seek immediate medical care if your child is struggling to breathe, stops breathing, loses consciousness, or shows signs of no airflow through the trach. 

Questions to ask your care team

• Is my child able to use a PMV?
• What are the benefits and risks of a PMV?
• How often should the PMV be cleaned?
• How long should my child wear the PMV each day? 
• Can my child use the PMV during meals or while sleeping?
• When should we not use the PMV?
• Will my child need speech therapy?
• When do we need to replace the PMV? 
• When should I call the care team or 911?

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