Tracheostomy

A tracheostomy is a surgical procedure in which a hole is made in the center of the neck that goes into the windpipe. If a tracheostomy is needed for only a short time, it will be closed later. Some people need the hole for the rest of their life.

A tracheostomy is necessary when the airway is blocked or when the passage of air between the mouth and the windpipe is obstructed. A  tracheostomy is also performed when a patient is on a breathing machine (artificial respiration) for a prolonged period of time. The tracheostomy helps to protect the voice box from the damage of having the pressure of a breathing tube resting against the vocal cords  for a long time. In rare cases, an emergency tracheotomy is performed when your airway is suddenly blocked, such as after a traumatic injury to your face or neck.

Situations that may call for a tracheostomy include:

  • Medical conditions that require the use of a breathing machine (ventilator) for an extended period, usually more than one or two weeks
  • Medical conditions that block or narrow the airway, such as vocal cord paralysis or throat cancer
  • Vocal cord paralysis, neurological problems or other conditions that make it difficult to cough up secretions from your throat and require direct suctioning of the windpipe (trachea) to clear your airway
  • Preparation for major head or neck surgery to assist breathing during recovery
  • Severe trauma to the head or neck that obstructs breathing
  • Other emergency situations when breathing is obstructed and emergency personnel can’t put a breathing tube through the mouth and into the trachea

How is a tracheostomy performed?
A tracheotomy is most commonly performed in an operating room with general anesthesia, which makes you unaware of the surgical procedure. A local anesthetic to numb the neck and throat is used if the surgeon is worried about the airway being compromised from general anesthesia or if the procedure is being done in a hospital room rather than an operating room.

Surgical tracheotomy can be performed in an operating room or in a hospital room. During a surgical tracheotomy, the surgeon usually makes a horizontal incision through the skin at the lower part of the front of the neck. The surgeon carefully pulls back the surrounding muscles and cuts through a small portion of the thyroid gland, exposing the windpipe (trachea). At a specific spot on the windpipe near the base of your neck, the surgeon creates a hole and inserts a tracheostomy tube into the hole. A faceplate and neck strap attached to the tube keep it from slipping out of the hole, and temporary sutures also can be used to secure the faceplate to the skin of the neck.

What to expect with a tracheostomy:
You’ll likely spend several days in the hospital as your body heals. During that time, you’ll learn skills necessary for maintaining and coping with your tracheostomy.

Caring for your tracheostomy tube:
A nurse will teach you how to clean and change your tracheostomy tube. In general, you’ll be asked to clean your tracheostomy site at least twice a day to help prevent infection. You’ll continue to do this as long as you have a tracheostomy.

Speaking. In general, a tracheostomy prevents you from speaking because exhaled air goes out the tracheostomy opening rather than up through your voice box. However, there are devices and techniques for redirecting airflow enough to produce speech. Depending on the tube size and design, the diameter of your trachea, and the condition of your voice box, you may be able to use your voice with the tube in place. If necessary, you’ll meet with a speech therapist or a nurse trained in tracheostomy care, who can suggest options for communicating and help you learn to use your voice again.

Eating. While you’re healing, you’ll receive nutrients through an intravenous (IV) line inserted into a vein in your body, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. When you’re ready to eat again, you may need to work with a speech therapist, who can help you regain the muscle strength and coordination needed for swallowing.

Coping with dry air. The air you breathe will be much drier since it no longer passes through your moist nose and throat before reaching your lungs. This can cause irritation, coughing and excess mucus coming out of the tracheostomy. You may use a device called a heat and moisture exchanger, which uses a small amount of warm, sterile salt water (saline) to humidify the air you breathe. Or you may use a tiny, disposable attachment for the tracheostomy opening, a humidivent, which captures moisture from the air you exhale and humidifies the air you inhale.

Coping with other effects. Your health care team will show you ways to cope with the other common effects of the tracheostomy. For instance, you may also learn to use a suction machine to help you clear secretions from your throat or airway.

Before you leave the hospital you should be able to:

  • Clean, replace, and suction the tracheostomy tube
  • Keep the air you breathe moist by using a special humdifier
  • Clean the hole with water and mild soap or hydrogen peroxide
  • Change the dressing around the hole

Do not perform strenuous activity or hard exercise for 6 weeks after surgery. After your surgery you may not be able to speak. Ask your doctor for a referral to a speech therapist to help you learn to talk with your tracheostomy.

Self-care:
You will have a small amount of mucus around the tube. This is normal. The hole in your neck should be pink and painless.

It is important to keep the tube free of thick mucus. You should carry an extra tube with you in case your tube gets plugged. Once you put in the new tube, clean the old one and keep it with you as your extra tube.

When you cough, have a tissue or cloth ready to catch the mucus coming from your tube.

Your nose will no longer keep the air you breathe moist. Talk with your doctor about how to keep the air you breathe moist and how to prevent plugs in your tube.

Some common ways to keep the air you breathe moist are:

  • Putting a wet gauze or cloth over the outside of your tube. Keep it moist.
  • Using a humidifier in your home when the heater is on and the air is dry
  • A few drops of salt water (saline) will loosen a plug of thick mucus. Put a few drops in your tube and windpipe, then take a deep breath and cough to help bring up the mucus.

Protect the hole in your neck with a cloth or tracheostomy cover when you go outside. These covers can also help keep your clothes clean from mucus and make your breathing sounds quieter.

Do not breathe in water, food, powder, or dust. When you take a shower, cover the hole with a tracheostomy cover. You will not be able to go swimming.

To speak, you will need to cover the hole with your finger, a cap, or a speaking valve.

Sometimes you can cap the tube. Then you might be able to speak normally and breathe through your nose and mouth.

Caring for Your Tracheostomy:
Once the hole in your neck is not sore from the surgery, clean the hole with Q-tips or a cotton ball at least once a day to prevent infection.

The bandage (gauze dressing) between your tube and neck helps catch mucus. It also keeps your tube from rubbing on your neck. Change the bandage when it is dirty, at least once a day.

Change the ribbons (trach ties) that keep your tube in place if they get dirty. Make sure you hold the tube in place when you change the ribbon. Be sure you can fit 2 fingers under the ribbon to make sure it is not too tight.