Chapter 27: Living with and beyond cancer
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Post‐procedural considerations
Ensure the patient is comfortable wearing the baseplate/laryngeal tube and that they can remove and replace the HME filter. Choice of HME in the acute post‐operative situation will usually be with a hypoallergenic baseplate. Use of a laryngeal tube as an option is usually recommended by the surgical team.
Immediate care
Once the HME is in place the patient is not required to do anything. If there is a voice prosthesis in situ the patient is shown how to occlude the filter to achieve voice.
Ongoing care
Speech and language therapists and nurses are responsible for teaching the patient how to remove and replace the HME device and monitor stoma size.
Cleaning
The voice prosthesis needs to be cleaned at least twice a day, more frequently when it is first inserted. It is also essential to clean it if the prosthesis leaks or if there is no voice (Procedure guideline 27.24).
The cleaning of a voice prosthesis is an advanced practice role of a specialist nurse who has met the required competencies (see Table 27.24).
Table 27.24 Competencies for cleaning a voice prosthesis in a laryngectomy patient
| Knowledge and understanding | Skills |
|---|---|
| Altered anatomy following a laryngectomy | An ability to recognize a laryngectomy versus a tracheostomy |
| The function of a voice prosthesis | An ability to recognize a voice prosthesis in situ |
| The importance of keeping the prosthesis clean | An ability to provide the patient/carer with relevant physical preparation for cleaning the prosthesis |
| Principles of brush selection | An ability to perform a safe cleaning technique with the appropriate equipment |
| Complications that may arise during or after cleaning, their cause and preventive measures | An ability to evaluate cleaning technique with regard to demonstrating knowledge and recognizing difficulties, their cause and future preventive measures |
Procedure guideline 27.24
Voice prosthesis: cleaning in situ
Table 27.25 Prevention and resolution (Procedure guideline 27.24)
| Problem | Cause | Prevention | Action |
|---|---|---|---|
| Loss of the prosthesis or stoma gastric catheter. | Accidental dislodgement or excessive coughing. | Teach patients how to insert the stent or catheter while on the ward. | Immediately insert either stent or catheter (Fr14 or smaller as needed) and secure with tape. Check that the patient has not inhaled the prosthesis; if they have, call for urgent ENT (Figure 27.41). |
| Peripheral leak. | Voice prosthesis too long.
Enlarged TEP. | Specialist Speech and Language Therapist (SLT) or another trained clinician to downsize as appropriate.
Specialist SLT and ENT to manage (Figure 27.42). | |
| Central leakage. | Food debris preventing closure of prosthesis. | Thickener added to all drinks. | Clean with a brush. Specialist SLT or another trained clinician (specialist nurse/ENT doctor) to change. |
| Loss of voice. | Debris blocking barrel of prosthesis.
Due to incorrectly sized prosthesis. | Clean with a brush.
Specialist SLT or another trained clinician to change device. | |
| Due to oedema in the TEP or voicing technique. | Specialized SLT to advise. |
Figure 27.40 Prosthesis brush.
Figure 27.41 Emergency management of a dislodged voice prosthesis. Source: Speech and Language Therapy Department, Royal Marsden Hospital NHS Foundation Trust. NG, nasogastric; NGT, nasogastric tube; SLT, Speech and Language Therapy.
Figure 27.42 Emergency management of a leaking voice prosthesis. Source: Speech and Language Therapy Department, Royal Marsden Hospital NHS Foundation Trust. ENT, Ear, Nose and Throat; H&N, head and neck; NBM, nil by mouth; NGT, nasogastric tube.
