Cost issues should be considered when devices are comparable in style and performance. Certain health insurance policies do not cover prosthetic supplies. Patients without prosthesis coverage should be provided cost options when selecting a device. When a prosthesis is dislodged, patients are instructed to insert a catheter into the puncture tract as soon as possible to maintain patency and prevent aspiration. If they are unable to place the catheter, they may arrive in the emergency department for puncture tract stenting.
Patients are sometimes unaware that they can phonate without the prosthesis.
As long as the puncture tract is patent, phonation is possible. Encouraging tracheoesophageal speech to explain their situation may ease patient anxiety. If the patient cannot speak, have them drink water, preferably with blue dye. If the water leaks through the puncture tract into the airway, the tract is patent. If no catheters are readily available, a duotube or nasogastric tube will work.