Adequate hospital care of laryngectomees

Neck breathers are at a high risk of receiving inadequate care when hospitalized. The medical staff is often not aware of their condition, do not know how to care for their airways, and may not know how to communicate with them. 

The COVID-19 pandemic created greater workload for hospital staff and may make it difficult to pay attention to laryngectomee’s special needs. Because most hospital limit or prohibit the presence of patients’ companions, making it more difficult for laryngectomees to communicate with the staff. It is therefore important to take certain steps to ensure that the care is adequate:

1. Inform the ward’s head nurse and attending physician about the laryngectomee’s general and specific needs. In case of elective admission, this can be done prior to the admission to allow the staff time to get ready and to get adequate supplies and equipment.

2. Inform the ward’s head nurse, attending physician and anesthetist (when undergoing a procedure with sedation or surgery) about the proper way of administrating anesthesia, suctioning, ventilating and intubation.   Show them the video in YouTube:  https://goo.gl/Unstch  Show them the video in YouTube:  https://goo.gl/Unstch (See video below). The video is available in DVD from Atos Medical. 

The National Patient Safety Project has developed an algorithm for emergency management of patients with laryngectomy. 

Rescue breathing for laryngctomees

DVD of Rescue breathing for laryngctomees

3. Inform the dietitian about the food requirements of the laryngectomee.

4. Inform and, when possible, meet with the hospital’s speech and language pathologist to ensure adequate care and availability of adequate supplies.

5. Laryngectomees who experience swallowing difficulties should request that the orally administered medications be given in liquid or easy to swallow form.

6. Request specific supplies and equipment to ensure adequate respiratory care, such as saline bullets, humidifier, and suction machine.

7. Keep reminding every staff member caring for the laryngectomee about his or her condition. This can be done by the patient and/or advocate.

8. Inform the head nurse; attending physician, and/or patient’s hospital advocate if medical care is not adequate or if errors are made.

9. Request that signs informing the staff about the laryngectomee are placed in the patient’s room.

10. Wear the hospital patient ID wristband on the same hand that identifies them as neck breathers. (See below) Because staff is required to continuously check the patient ID wristband, they will be reminded of the condition.

11. Make sure that the laryngectomee is able to communicate with staff. Those using tracheoesophageal speech may need to use alternative speech methods such as an electrolarynx and/or communicate through writing and speech generating devices, i.e., laptop, smartphone, etc.

12. Preparing a kit with essential information and material when going to the hospital

• The kit should contain the following:
• An updated and current summary of the medical and surgical history, allergies and diagnoses
• An updated list of the medications taken and the results of all procedures, radiological examinations, scans and laboratory tests. These may be placed on a disc or USB flash drive
• Contact information and proof of medical insurance
• Information (phone, email, address) of the laryngectomee’s physician(s), speech and language pathologist, family members and friend(s)
• A figure or drawing of a side view of the neck that explains the anatomy of the laryngectomee's upper airways and if relevant where the voice prosthesis is located
• A paper pad and pen
•  An electrolarynx with extra batteries (even for those using a voice prosthesis)
•  A box of paper tissues
• A supply of saline bullets, HME filters, HME housing, and supplies needed to apply and remove them (e.g., alcohol, Remove, Skin Tag, glue) and to clean the voice prosthesis (brush, flushing bulb)
• Tweezers, mirror, flash light (with extra batteries)