Preparations For A Secure Hands-Free Seal
by Richard Crum
I am not a speech pathologist or a doctor, just a fellow laryngectomee. My surgery was in July of 1988, and in 1992, I went to work as a laryngectomee consultant for InHealth Technologies. During that time, I have talked with many people about their problems using a hands-free system for speech. I have used the hands-free valve from InHealth since my surgery and have put on the housing to hold my hands-free valve over 5,500 times. Since 1999 I have used the Blom-Singer TruSeal housing that I put on in the morning and take off before going to bed. I very rarely break a seal and I work every day.
While I still think that backpressure is a major cause for the seal to fail, I have started to realize that improper skin prep and the method used to attach the housing is also a problem. I would like to review how I prepare my skin and how I attach the housing.
The first thing that I do is to make sure the prosthesis is clean and free of any mucus build up over the night. I am currently wearing a 10mm Advantage Indwelling Prosthesis from InHealth. I clean it with the brush provided and then flush it at least 6 times with a flushing pipette.
After I shave I use a wet, soapy washcloth to thoroughly clean and rinse the area around my stoma. I then dry my skin with a fresh, dry towel. Using a large alcohol pad, I thoroughly wipe the area around the stoma. It is very important to remove the natural oil that all of us have on our skin. I dry the area again with a dry cloth.
I apply a coat of Shield Skin skin prep on the skin around my stoma. I personally prefer Shield Skin; however, Skin-Prep will work as well. I dry the area where Shield Skin is applied using my hair dryer. It is very important that this product is thoroughly dry. The Shield Skin acts as a plastic wrap for the skin. It does two things. First, it fills in the valleys of the skin to make the skin very smooth. Second, it protects the skin from the adhesive on the housing. After the Shield Skin is dry, I apply a thin layer of Silicone Adhesive. I usually put on one brush full around one side of my stoma and then another brush full around the other side of my stoma. I then use my hair dryer again to dry the Silicone Adhesive. After it is thoroughly dry, I apply a TruSeal housing.
With my left hand I stretch the skin so it is as smooth as possible. Holding the TruSeal by the center ring, I carefully apply the TruSeal with my right hand; then, very carefully smooth the TruSeal. After that, I am ready to go to work. This approach works just as well if you are using the Tracheostoma Valve housing and adhesive discs. When I was using this system I used the heavy-duty tape discs.
I cannot stress enough the importance of proper skin preparation when using a hands-free system. It is very important to thoroughly dry, between applying the Shield Skin or Skin-Prep, the silicone adhesive, and applying the housing. I choose to do it with my hair dryer to cut down on the time it takes. If you do not use a hair dryer, wait at least 5 minutes between each step. Another reason I like to use a hair dryer is to avoid coughing and getting phlegm on my skin which would cause me to start over or not keep a seal.
I never use any type of adhesive remover. These products tend to do their job very well but seem to have a residual effect. I have found that using this type of product makes it difficult to keep a seal because the adhesive remover will work to break down the adhesive. I have found also that alcohol and a wet washcloth will get most of the adhesive off of my skin.
While it is very important to apply the housing properly, you will continue to have problems keeping a seal if you have a backpressure problem. Backpressure is created when you take air from your lungs and direct it to the prosthesis. The prosthesis is a very small tube that lets air pass from your trachea (air passage) into your esophagus (food passage). The prosthesis can only accept a small amount of air. The remainder of the air
in your stoma will push from the inside against the housing. If this pressure is too great, it will force the housing to loosen and finally break. This will allow air to leak out of the housing and not go through your prosthesis.
To correct this problem it is important to understand what is going on inside your stoma. I have described it as getting inside your stoma. When you start using a hands-free device you need to be aware of how much pressure is inside your stoma. When you feel like you have too much pressure, you need to back off and lower your volume. When you learned to ride a bike you would fall off over and over and then one day you would learn to keep you balance. This is the same process that you will need to use when you start using a hands-free device. You probably will not be able to use it right the first time you use it. You will need to practice until you get the feel of it.
Using a hands-free system is a two-step process. If the skin is not prepared properly you will not be able to keep a seal and if you have too much backpressure you will not be able to keep a seal. I have been doing this for a long time and have done a lot of trial and error. The system that I have just described works well for me. I hope that this will help if you are learning how to use a hands-free system.
Richard Crum, Consultant for InHealth Technologies, September 14, 2005