Tracheostomy

What is a tracheostomy?

When you breathe, air comes in through your mouth or nose. It then flows down a tube in your throat called the trachea and into your lungs. However, if in the event you can’t breathe this way, a tracheostomy can be done to help you breathe.

A tracheostomy is also known as a trach (pronounced trake).

During a tracheostomy, a healthcare provider creates a small hole in the lower part of the front of the neck. A small tube is put into the hole. A manual airbag or breathing machine is connected to the tube. This allows air to go straight into your trachea and into the lungs instead of first going through the nose or mouth into the trachea and then into the lungs. 

Why might I need a tracheostomy?

You may need a trach because your airway is blocked because of sudden injury, swelling that blocks the airway, or infection. Tracheostomy is also done for problems swallowing or clearing mucus from the airways due to weak muscles, such as may occur after a stroke. These problems may be because of issues such as birth defects, burn injuries, severe allergic reactions, need for chronic respiratory support with a mechanical ventilator, severe sleep apnea, or traumatic injuries. Or these problems may be because of surgery to remove the voice box (larynx).

Most often, tracheostomy is done because a breathing machine (ventilator) is needed for a few weeks or longer. A ventilator blows air into the lungs through the tube put into the trach hole. Using a trach may prevent damage to the upper airway or vocal cords caused by putting an air tube through the mouth or nose for a long time.

If the tracheostomy is done in an emergency, the hole may be needed only for a short while. But in some cases, it may be needed permanently.

What are the risks of a tracheostomy?

Like any surgery, a tracheostomy has some risks. These include:

• Bleeding or infection

• Nerve damage

• Damage to nearby blood vessels

• A buildup of air between a lung and your chest wall (pneumothorax) that can lead to a collapsed lung

• An abnormal connection (fistula) between the trachea and the tube that takes food and liquid from your mouth to your stomach (esophagus)

• Irritation of the lining of the windpipe

• Failure of the hole to close after the tracheostomy tube is no longer needed

• Scar on the neck 

• Death

You may have other risks, depending upon your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the tracheostomy procedure, if possible.

How do I get ready for a tracheostomy?

In some cases, a tracheostomy is done in an emergency. You may not have time to prepare. Or you may not be conscious. It may be done at the bedside in your hospital room at a moment's notice. Sometimes a tracheostomy needs to be done at the scene of an accident.

In these cases, when possible, you will be given local anesthesia on the neck to prevent pain. The neck area is cleaned. A cut is made in the lower front part of the neck. A thin tube is put in the hole. A manual airbag is then attached to an oxygen supply is connected to the tube. When the bag is squeezed, air is pushed into the lungs as a way to artificially breathe.

For other kinds of tracheostomy, you will have time to prepare.

Ask your healthcare provider to tell you what you should do before your tracheostomy. Below is a list of common steps that you may be asked to do.

• Weeks to days before the procedure, your healthcare provider will explain the procedure and ask if you have any questions.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is unclear.

• Your healthcare provider may do a physical exam to ensure you are in otherwise good health before you undergo the procedure. You may also have blood tests and other diagnostic tests.

• Your healthcare provider may recommend taking an aspirin before the procedure.

• Tell your healthcare provider if you are pregnant or think you could be.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, contrast dyes, and anesthesia (local or general).

• Tell your healthcare provider of all prescribed and over-the-counter medicines, and herbal supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop certain medicines before the procedure.

• If you smoke, stop smoking as soon as possible before the procedure. This will help improve your chances for a successful recovery from surgery and your overall health.

• Follow any directions you are given for not eating or drinking before surgery.

What happens during tracheostomy?

• You will be asked to remove any jewelry.

• If you are not already in a hospital gown, you will be asked to change into a hospital gown.

• You will lie down on a surgical table.

• Your heart rate, blood pressure, breathing rate, and oxygen level will be watched and recorded before and during the procedure.

• You may be given extra oxygen as needed through a facemask or nasal tube.

• To prevent pain or discomfort, you will be given local anesthesia. Or you may be given general anesthesia. This puts you in a state like deep sleep during the procedure.

• The procedure should take about 20 to 45 minutes.

• The skin on your neck is cleaned with an antiseptic solution.

• The healthcare provider cuts through the skin in the lower part of the front of your neck.

• The thyroid gland is pushed out of the way. In some cases, it may be separated in the middle to allow room for the tracheostomy tube.

• The healthcare provider makes a cut in the trachea.

• Next, the healthcare provider will place a tube into the hole to keep it open and allow air to pass through it.

• The healthcare provider will use stitches to keep the tube (cannula) in place.

Talk with your healthcare provider about what you can expect during your procedure.

What happens after tracheostomy?

Your healthcare provider may give you other instructions about what to do after your procedure. Here is a typical list.

• Your healthcare team may give you medicine to make you feel relaxed after the procedure.

• Depending why you need the trach, you may need to stay in the hospital for a week or more.

• Be aware that you will not be able to talk after a trach unless a special tube is used. This is not a permanent condition (unless you need the trach permanently) and will resolve once the trach is removed.

• If your trach is temporary, once the tube is removed you’ll be given instructions for how to care for the wound. The hole should heal in a few days.

• Medicine will be provided in the hospital to help control any pain or discomfort from the procedure or nausea following sedation.

• If your trach is needed for a longer period, you’ll be given instructions for how to manage and care for it.

• You may not be able to eat by mouth for the first week or two. Instead, you may receive nutrition through an IV line in a vein or through a feeding tube put through your nose or mouth to your stomach.

• You may need to learn how to swallow again before you can start to eat normally. You will also have to learn how to speak with the trach tube in place. Therapists or other healthcare team members may help you with these tasks.

• You may also need to use a device to keep your airway moist, particularly if you are receiving oxygen through a tube. One option is a device called an "artificial nose," or HME (heat and moisture exchanger), which goes over the end of the trach tube and holds in moisture.

• Ask your healthcare provider about things you need to do each day to keep your tracheostomy clean and your airways clear. These include changing or cleaning the tube that goes down into the airway, cleaning the skin around the opening, and changing the ties that hold the trach tube in place.

• Also ask your provider what to do if you're having trouble breathing because of a blockage in the tracheostomy tube or your airway. This can be life-threatening.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would  happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure