Slide 1. Introduction to Housings and Heat Moisture Exchange Kristi DeHaan, MS, CCC/SLP. Slide 2. Slide 3. Objectives

Transcription

1 Slide 1 Introduction to Housings and Heat Moisture Exchange Kristi DeHaan, MS, CCC/SLP Ear, Nose & Throat Clinics of San Antonio TLA 2019 Slide 2 Kristi DeHaan is employed by the ENT Clinics of San Antonio. She has no financial disclosures. Slide 3 Objectives 1 Understand how HME systems improve pulmonary health 2 Identify patients who would benefit from HME s 3 Choose appropriate housings based on patient s individual needs

2 Slide 4 Normal Respiratory System Nose warms air 20+ degrees Humidifies air Filters dust/debris Slide 5 Normal Respiratory System Trachea, bronchi and nose are lined with cilia that transport mucus Slide 6 Upper Respiratory Tract Defense Mechanism - Cilia Tiny hair-like structures that move in a wave-like motion to sweep away mucus and dirt from the epithelial surface.

3 Slide 7 Upper Respiratory Tract Defense Mechanism- Goblet Cells Produce more mucus in response to irritants to protect airway Mucus in goblet cell granules is condensed; When secreted in response to stimuli, mucus expands in volume dramatically and quickly like pressurized whipped topping Slide 8 Post- Laryngectomy Slide 9 Post- Laryngectomy Laryngectomy patients are now neck breathers They lose their primary defense mechanism to moisturize and purify air after surgery

4 Slide 10 Post- Laryngectomy Respiratory System Ciliary activity is reduced due to lack of moisture and heat. Mucus production increases due to breathing in large particles of dust and cold/dry air Dry, crusty mucus may block airway Coughing increases Slide 11 Laryngectomy Patients At the trachea, air temp is degrees Relative Humidity is about 45% Patient may lose up to 1 liter of water per day through unprotected stoma Slide 12 Heat and Moisture Exchanger to the Rescue Increases relative humidity to 70% Increases temperature to 91 degrees Improves movement of cilia which clears mucus References: ATOS Medical Hilgers, Ackerstaff, Aaronson, Schouwenburg, van Zandwijk. Clin Otolaryngol 1990;15:421-5 Ackerstaff, Souren, van Zandwijk, Balm, Hilgers. Laryngoscope 1993;103; Ackerstaff, Hilgers, Balm, van Zandwijk. Clin Otolaryngol 1995;20: Ackerstaff, Hilgers, Meeuwis, Knegt, Weenink. Clin Otolaryngol 1999;24:491-4.

5 Slide 13 HME Improves QOL Reduces coughing Mucus is thinned and easier to expel Sleeping improves Self Image Slide 14 ATOS Medical Provox HME ATOS Medical Provox HME Cartridge Front View Posterior View XtraFlow and XtraMoist Slide 15 InHealth Technologies Blom-Singer HME Cartridge Classic Flow Easy Flow

6 Slide 16 ATOS Medical Provox Micron HME Bacteria, virus and filter Provox Luna HME Nighttime Slide 17 Who can wear an HME? Any laryngectomee post-op with larytube Change filter every 24 hours or more frequently if needed Clinician should introduce HME as quickly as possible Slide 18 Which is Best? Intraluminal vs. Peristomal

7 Slide 19 PATIENT SELECTION Time since surgery or radiation Stomal topography Skin irritation and edema Stoma Integrity Slide 20 Intraluminal and Peristomal Topography Symmetry: size, shape Deep set SCM prominent EL or TEP Speaker Financial considerations Maintain seal 8 hours Slide 21 Oval Stoma, Prominent SCM

8 Slide 22 HME Housing Options - Intraluminal Larytube Larybutton or Barton-Mayo Slide 23 INTRALUMINAL Larytubes, Larybuttons, Barton-Mayo Buttons Non-disposable: cost effective Easy for patients to place Help keep stoma patent, especially post-op and during radiotherapy Larytubes can be fenestrated for TEP speech May stay in place alone or can be paired with LaryClips or neck strap Slide 24 Intraluminal ATOS Medical Provox Larytube ATOS Medical Provox Larybutton Barton-Mayo Buttons

9 Slide 25 Securing Larytube or Larybutton Provox LaryClips Provox Larytube Holder Slide 26 Mr. P Slide 27 Peristomal Adhesive Housings

10 Slide 28 PATIENT SELECTION Time since surgery or radiation Stomal topography Skin irritation and edema Stoma Integrity Slide 29 Choosing Baseplate Try the various InHealth and ATOS products. Choose the shape that fits the stoma best. If TEP speaker, determine which adhesive is most stable Slide 30 InHealth BlomSinger Adhesives TruSeal Contour Low Profile TruSeal Contour Adhesive Housing TruSeal Adhesive Housing

11 Slide 31 InHealth TruSeal Contour Low Profile Lightweight Flexible Thinner than standard housing Slide 32 InHealth TruSeal Lightweight Disposable All-inclusive adhesive Higher profile for decreased dexterity Slide 33 InHealth Tracheostoma Valve Housing Attaches to ATSV II, HME, or Shower Guard Use separate tape disc & adhesive in varying thicknesses and width Reusable

12 Slide 34 ATOS Provox Adhesives FlexiDerm and Optiderm: Round, Oval, Plus XtraBase: Round StabiliBase Luna Slide 35 ATOS Provox Adhesives FlexiDerm Round FlexiDerm XtraBase -Ideal for flat stoma -Ideal for deeper stoma, hands-free -Convex shape with rigid center Slide 36 ATOS Provox Adhesives - OvaL FlexiDerm OptiDerm -Larger surface area, flat stoma -Irritated skin post-op or after XRT

13 Slide 37 ATOS Provox Adhesives Provox Stabilibase Luna Hydrogel -Deep Set Stoma, Hands-Free -Nighttime Slide 38 Application of Adhesives Clean area around stoma to remove excess oil Use Skin Tac Wipe around stoma. Wait 2 minutes. Slide 39 Application of Adhesives Choose base plate that fits the stoma best Warm it up! Remove backing from adhesive Line up bottom rim of inner plastic ring with bottom lip of stoma Stretch skin around stoma to smooth wrinkles from skin

14 Slide 40 Application of Adhesives Smooth out wrinkles or bubbles in baseplate to improve adhesion to skin. Gently rub adhesive for a minute or two Slide 41 Application of Adhesives Place HME filter in plastic ring. Do not attempt to speak for minutes if using TEP Slide 42 Removal of Adhesive Use adhesive remover wipes to minimize skin irritation

15 Slide 43 Mr. O Slide 44 Mr. G Slide 45 Mr. T Provox XtraBase

16 Slide 46 Ms. H Provox StabiliBase Adhesive Slide 47 Mr. Z - Deep set with Kapi-Gel Slide 48 Mr. L

17 Slide 49 Ms. H Slide 50 Mr. Frank Slide 51 Mr. B

18 Slide 52 Thank you for! References, pictures and information provided by: ATOS Medical: InHealth Technologies Patients of ENT Clinics of San Antonio SITNBoston: Hilgers, Ackerstaff, Aaronson, Schouwenburg, van Zandwijk. Clin Otolaryngol 1990;15:421-5 Ackerstaff, Souren, van Zandwijk, Balm, Hilgers. Laryngoscope 1993;103; Ackerstaff, Hilgers, Balm, van Zandwijk. Clin Otolaryngol 1995;20: Ackerstaff, Hilgers, Meeuwis, Knegt, Weenink. Clin Otolaryngol 1999;24:491-4