The patient was able to tolerate a 5-minute placement of the Passy-Muir valve.  He reported no discomfort on the inhalation; however, he felt some resistance on exhalation.  Instructions were given on care placement and cleaning of the Passy-Muir valve.  The patient was instructed to buildup tolerance over the next several days of his Passy-Muir valve and to remove the valve at anytime or he is going to be sleeping or napping throughout the day.  The patient's voicing did improve with the Passy-Muir valve due to decreased leakage from his trach secondary to finger occlusion.  Mucus production also seemed to decrease when the Passy-Muir was placed.