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Definition

Tracheotomy is the surgical creation of an opening from the outside of the neck into the windpipe. A tube is inserted into the opening to allow for normal breathing.

Tracheostomy
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Reasons for Procedure

A tracheotomy is done to bypass obstructions that are interfering with breathing. The opening is called a stoma or tracheostomy. A stoma may be either temporary or permanent.

A tracheotomy is done to restore normal breathing in the following situations:

  • The airway is obstructed at or above the level of the larynx, which is also known as the voice box, due to:
    • Trauma to the neck area
    • Obstructing tumors in the upper airway
    • Vocal cord paralysis
    • Removal of larynx for throat cancer
  • Respiratory failure requiring long-term mechanical breathing assistance, as in these cases:
    • Spinal cord injury in the neck area
    • Severe lung infection or inflammation
  • If you have been on a ventilator for 21 days
  • Injury to the respiratory tract due to breathing in smoke or steam or inhaling corrosive substances
  • Birth defects of the trachea or larynx
  • Foreign object blocking the trachea or larynx
  • Severe sleep apnea

Possible Complications

If you are planning to have a tracheotomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Infection
  • Damage to the vocal cords, vocal cord nerves, or esophagus
  • Damage to the lungs
  • Difficulty swallowing
  • Air trapped in tissue under the skin of the neck
  • Low blood pressure
  • Tracheostomy tube displacement or damage
  • Scarring at the site of operation leading to closure of the tracheostomy or tracheal narrowing
  • Abnormal connection to esophagus or surrounding blood vessels

Some factors that may increase the risk of complications include:

  • Age: infants and elderly adults
  • Obesity
  • Smoking
  • Poor nutrition
  • Recent illness, especially an upper-respiratory infection
  • Alcoholism
  • Long-term illnesses
  • Use of certain prescription and nonprescription drugs

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Chest x-ray
  • Blood and urine tests
  • Review of medications

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:

  • Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
  • Blood-thinning medications
  • Anti-platelet medications

Anesthesia

General anesthesia will be used. You will be asleep. In emergency situations, local anesthesia may be used. It will numb the area.

Description of Procedure

A cut will be made in the skin of the neck. A section at the front of the windpipe will be removed. A tracheostomy tube, which will act as the airway, will then be fitted into this opening in the windpipe. The skin will be closed around the tube with stitches or clips.

Immediately After Procedure

You will breathe through this tube as long as it is in place. Oxygen and machines to assist breathing will be provided, if needed. A chest x-ray may be needed.

How Long Will It Take?

About 15-30 minutes

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. You may have some pain and soreness during recovery. Your doctor can prescribe pain medication to help relieve this discomfort.

Average Hospital Stay

The length of stay will depend on the reason for the procedure. Most stays are 1-5 days.

Post-procedure Care

  • Keep the stoma area and incision clean and dry. Clean it daily with mild soap and water or with hydrogen peroxide.
  • Wash your hands before changing the dressing. Replace the dressing with a clean dry one.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water. You may be advised not to get water on the stoma.
  • Learn the proper daily care of your tracheostomy tube . This will help maintain its long-term health and function. Care includes the following, which you will be taught shortly after the surgery:
    • You will need to learn removal and replacement of the tube if it becomes blocked or dislodged.
    • Proper cleaning of the tube
    • Suctioning the tube regularly to keep it from becoming blocked with secretions
    • Apply mist through your tracheotomy tube at least during the night to prevent blockage of the tube
    • Covering the tracheostomy hole with a scarf or other cloth when going outside, so that dust, dirt, and other foreign particles cannot get in
    • Being very cautious about breathing in water or small particles through the tracheostomy such as food bits, powders, aerosol sprays, dust
  • Consult a speech therapist if recommended by your doctor.
  • Take antibiotics, if prescribed by your doctor.
  • Return to daily activities and work as soon as possible to promote healing.
  • Avoid vigorous exercise for six weeks after surgery.
  • Be sure to follow your doctor’s instructions.

Once a tracheostomy tube is in place, you will experience breathing and vocal changes. It usually takes three days to adjust to breathing through the tube. Speaking is often a larger adjustment. Initially, you may not be able to speak. You will need to cover the tracheostomy hole with your fingers in order to speak so the air going in and out of the tube will not bypasses the vocal cords.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including cough, excessive foul-smelling mucous, fever, and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medications you have been given
  • Cough, shortness of breath, or chest pain
  • New, unexplained symptoms

In case of an emergency, call for medical help right away.

You should call for help right away if:

  • Your tracheostomy tube falls out and you can't replace it
  • You are having difficulty breathing through your tube

Revision Information

  • American Lung Association

    http://www.lungusa.org

  • National Heart Lung and Blood Institute

    http://www.nhlbi.nih.gov

  • Canadian Medical Association

    http://www.cma.ca

  • The Lung Association

    http://www.lung.ca

  • Caring for your tracheotomy. University of Miami Health System website. Available at: http://calder.med.miami.edu/pointis/traccare.html . Accessed September 17, 2013.

  • Frequently asked questions about tracheotomy and swallowing. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/slp/clinical/frequently-asked-questions-on-tracheotomy-and-swallowing/ . Accessed September 17, 2013.

  • Tracheostomy (putting a breathing tube through a small hole in the throat). American Thoracic Society website. Available at: http://www.thoracic.org/clinical/critical-care/patient-information/icu-devices-and-procedures/tracheostomy-putting-a-breathing-tube-through-a-small-hole-in-the-throat.php . Accessed September 17, 2013.

  • What is a tracheostomy? Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/tracheostomy/about/what.html . Accessed September 17, 2013.