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Directions for TEP Plug Usage

DIRECTIONS FOR MANAGING A LEAKING TEP:

  1. If liquid comes through your TEP when you drink, you will need to place a PLUG to stop the liquid from going into to your airway, making you cough.
  2. You will need to place the plug during ALL meals. You will not be able to talk with the plug in place, but it will stop your prosthesis from leaking during eating or drinking.
  3. The SIZE of the plug is very important. It will not fit correctly if you do not have the correct size. The size of your prosthesis and plug must be the same for them to fit together.
  4. There are three different sizes: 17Fr, 20Fr, 22.5Fr. You can locate it on the large end of the plug.
  5. If you are leaking it is not an emergency, follow the steps below. Do not go to the ER.

HOW TO PLACE A PLUG:

  1. Find one of your blue, TEP cleaning brushes.
  2. Place the small, round end of plug onto the end of the blue cleaning brush (the plug does not go on the bristled end).
  3. Gently push the plug into the CENTER of the prosthesis until you feel it click or pop into place.
  4. Tape the big end of the plug to the skin outside your stoma. The big end is made larger so it cannot fall into your stoma. The tape helps hold the plug in safely while you are eating or drinking.
  5. Remember, you ca not talk when the plug is in place, but you can eat and drink safely.
  6. Remove the plug after meals so you can talk.
  • Call 601-815-6064 with any questions or concerns regarding TEP leakage or plug usage.
  • If you do not have the correct SIZE of plug, cannot FIND your plug, or are not able to PLACE your plug, call the UMMC SLP at 601-815-6064.
  • We will help will ordering supply and troubleshooting plug placement with you.
Identifying and stopping leakage through your prosthesis:
  1. Stand in front of a mirror with a good light.
  2. Clean your voice prosthesis using your brush.
  3. To see if your prosthesis is leaking follow these steps:
    1. Take a sip of colored liquid (i.e. milk, coffee, juice) so that it is easy to see.
    2. Look to see if any of the liquid leaks through or around the prosthesis.
    3. If nothing is leaking through take a larger sip of the liquid and check again.
    4. If you cannot see your prosthesis clearly, ask someone to look for you.
      If the leaking has stopped after cleaning with the brush it might have been a bit of food or liquid keeping the valve open temporarily. Clean your voice prosthesis SEVERAL TIMES A DAY.
  4. If LEAKAGE through the prosthesis continues you will need to place a plug to stop-up the prosthesis during meals until you can have it changed by your SLP. This will allow you to eat and drink safely for a few days while you wait to get an appointment with your speech pathologist and you can avoid going to the ER. ***The ER does not carry replacement prostheses.
  5. Placing your plug into your prosthesis is easy, just follow these steps:
    1. Place the plug on the end of the cleaning brush (Provox) or on the inserter (InHealth).Your plug is specific to the type of prosthesis you have in place. Gently push the plug into the center of the prosthesis until you feel it click or pop into place.
    2. Tape the big end of the plug to the skin outside of the stoma. The big end is made larger so it cannot fall down into your stoma. The tape is just extra security and will hold it securely in place while you are eating or drinking. Remember you cannot talk while the plug is in place but you can eat safely.
    3. Remove the plug after meals and you can talk. You will need to see your SLP in the next few days to have the prosthesis changed out.
  6. Call your UMMC speech pathologist at 601-815-6064 to schedule a TEP Evaluation and changing.
    ***If you are having trouble swallowing (getting food to go down) you may have a stricture or tightening from your previous radiation and you will need an appointment with your physician/nurse practitioner to evaluate your situation and potentially schedule you for a surgery to stretch your esophagus. This procedure is commonly needed after a laryngectomy surgery. The MD/NP will need to determine if there is a possible stricture and/or order a swallow study or if there is another reason for your swallowing problems.

TIPS FOR REDUCING LEAKAGE THROUGH TEP

  1. USE YOUR PLUG. Your plug is the best way to stop 100% of all leakage.
  2. Thin liquids such as water, tea, juice will cause more leakage. Examples of thin liquids are: water, coffee, milk, soda, Ensure, carbonated drinks, tea.
  3. Place your finger over the prosthesis while drinking or eating and this will stop leakage from coming through. You may also try placing a straw over the prosthesis and allow it to funnel the liquid down the straw and into the cup you are holding the straw in.
  4. Drink thicker liquids. Thicker liquids will move slower and are less likely to go through your TEP, causing you to cough. Examples of thick liquids are: milkshakes, thick-cream based soups, ice cream, frozen yogurt
    1. Adding thickener to regular thin liquids (water, tea, juice, soda) will make them thicker and less likely to  go through your TEP.
  5. Alternate LIQUID AND SOLID swallows. Eat the solid food first. This can help stop up the prosthesis and prevent liquid from being able to pass through the TEP during a meal.

Tips for preparing nectar thick liquids:

  • Add the thickener packet to the liquid, and stir well for 20 seconds. Allow the drink to sit for at least 1 to 2 minutes to get the right thickness before serving or drinking.
  • If the liquid is too thick, thin liquid can be added to reduce it to a thinner consistency.
  • If the liquid is too thin, a small amount of thickener can be added. Do not “under thicken” liquids. It’s better to drink a liquid that is too thick than too thin.
  • When thickening hot drinks, be aware that as the drink cools off, it tends to get thicker.

Where to purchase thickening powder or pre-thickened products:

  • Thickening powders can be purchased from local drug stores or directly from companies that make them. Some brand names include: Thick It, Thick n’ Easy, and Thixx.
  • You can also purchase pre-thickened beverages such as juice and milk from certain companies. Below are a list of places where thickened beverages or thickening powders can be purchased:
  • This list is intended as a patient resource only. UMMC does not endorse or recommend any brand of thickener or supplier of these products over the other.

Questions? Call UMMC Speech-Language Pathology 601-815-6064.

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