Provox® ActiValve®: Overview of use, care and placement

0:00 - Overview of Provox ActiValve
1:40 - Care and maintenance
2:34 - Determine the strength for your patient
3:59 - Voice prosthesis placement
7:20 - Contraindications
7:35 - Conclusion
Provox ActiValve is primarily designed for laryngectomy patients who experience early leakage through the voice prosthesis the blue fluoroplastic material of the valve flap and valve seat help prevent the accumulation and infiltration of biofilm which can disrupt the function of the valve and cause early leakage there are two magnets which prevent the valve flap from opening inadvertently when the user breathes or swallows active valve is available in three magnet strengths light strong and extra strong
Evidence shows the provox active valve has the longest median device life compared to other voice prostheses*
Provox ActiValve is designed to address early leakage due to biofilm buildup negative pressure or a combination of the two the device is made of a medical grade silicone rubber and radio opaque fluoroplastic the valve and valve seat or ring are both made of blue fluoroplastic in order to prevent the buildup of biofilm which is the most common cause of early leakage to address negative pressure every ActiValve has a magnet located on the valve flap and another magnet embedded within the valve seat the strength of these magnets helps to prevent unintentional opening during breathing and swallowing for care and maintenance there are two brushes included with your Provox ActiValve one brush for cleaning and one for applying lubricant it is important to keep the brush as dedicated as only a cleaning brush or only a lubricant brush use the provox brush dedicated for cleaning to brush the prosthesis two times a day and after each meal to remove mucus and food remnants from the prosthesis after brushing flush the prosthesis with the provox flush after brushing and flushing in the morning lubricate the inner lumen of the voice prosthesis with one drop of provox active valve lubricant using the provox brush dedicated for lubricant use
if short device life is due to excessive biofilm buildup and negative pressure is not suspected then start with the Provox ActiValve light if short device life is due to suspected negative pressure resulting in inadvertent valve opening during breathing or swallowing with or without biofilm then begin with the Provox ActiValve strong it is not recommended that you start your patient in the Provox ActiValve extra strong however if your patient has persistent central leakage due to inadvertent opening from negative pressure while in a Provox ActiValve strong you may consider placing an extra strong
it is important to remind the patient that the use of the Provox ActiValve is to solve for leakage and aspiration patients may feel the need to use slightly more force to initiate speaking but once the initial magnetic force is overcome speaking efforts should be similar to other provox voice prostheses
for a first-time user of the Provox ActiValve schedule follow-up visit within three weeks of placement to ensure adequate voicing and leakage management thread the safety strap of the active valve into the keyhole shaped area of the inserter pin
pull it into the narrower part of the slit to lock into place
place the active valve on top of the inserter pin
fold the esophageal flange forward by pinching it together like a taco
hold the loading tube with your other hand and insert the esophageal flange into the opening in the tube it is important to keep flanges folded forward as you advance the prosthesis in the clear loading tube
advance the prosthesis with the inserter pin until the active valve reaches the base of the tapered tip at the end of the clear loading tube
the line marked one on the inserter pin should now align with the bottom edge of the clear loading tube gently insert the loading tube into the te puncture until the tip of the tube is completely inside of the puncture insert the prosthesis by holding the loading tube stable with one hand and pushing the inserter pin forward with your other hand until the line mark 2 advances to the edge of the loading tube
pull back gently on the loading tube and inserter pin until you feel the esophageal flange of the voice prosthesis reach the anterior esophageal wall you will see the tracheal flange of the voice prosthesis unfold as you remove the clear loading tube
check for proper positioning by rotating the prosthesis to ensure it is spinning freely
then lightly pull on the pin to confirm the prosthesis is securely in place once placement is confirmed but prior to cutting the safety strap rotate the voice prosthesis so the safety strap is pointing downwards in the six o'clock position check the function of the voice prosthesis by asking the patient to speak once the patient is speaking fluently ask them to drink water and observe the prosthesis to ensure no leakage is occurring
prior to cutting the safety strap