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A tracheostomy, also known as a tracheotomy, is a medical procedure that involves creating an opening in the neck in order to place a tube into a person’s trachea, or windpipe. The tube may be temporary or permanent. It’s inserted through a cut in the neck below the vocal cords that allows air to enter the lungs. Breathing is then done through the tube, bypassing the mouth, nose, and throat. The hole in the neck that the tube passes through is commonly known as a stoma. Did you know? Any medical procedure where the skin is broken carries the risk of infection and excessive bleeding. There’s also a chance of an allergic reaction to anesthesia, although it’s rare. Tell your doctor if you’ve had an allergic reaction to anesthesia in the past. Risks specific to a tracheostomy include:
Rare risks include erosion of the trachea and a fistula, which is an abnormal tunnel between two parts of the body. A fistula, commonly called a tracheoinnominate fistula, may occur between:
Babies, people who smoke, and older adults have a greater risk of complications from a tracheostomy. If your tracheostomy is planned, such as for people having cancer surgery, the doctor will tell you how to prepare. Preparation will involve fasting beforehand. If your tracheostomy is performed during an emergency, there will be no time to prepare. How to plan for a hospital stayIf you’re having a planned tracheostomy, there are several things you can do to prepare for your hospital stay. Planning can help you feel more relaxed and confident before the procedure. It can also help with recovery. Take the following steps:
For most tracheostomies, you’ll be given general anesthesia. This means you’ll fall asleep and will not feel any pain. Some people have severe airway problems and cannot be intubated. They’ll undergo a rare procedure known as an awake tracheostomy. In an awake tracheostomy, your airway is kept open by your respiratory drive. You’ll also be injected with local anesthesia. Anesthesia numbs the area of your neck where the hole is made. The procedure will begin only after the anesthesia has started working and usually takes 20 to 45 minutes. Surgical tracheostomy includes the steps below:
In pediatric tracheostomy Percutaneous tracheostomy is minimally invasive but comes with a greater risk of airway damage. This technique includes the steps below:
Percutaneous tracheostomy is rarely performed on children. Adapting to a tracheostomy tubeIt typically takes a few days to adapt to breathing through a tracheostomy tube. It will take about 1 week for the opening to heal. During that time, your doctor may replace the tube. Talking and making sounds also takes some practice. This is because the air you breathe no longer passes through your larynx. For some people, covering the tube with a small plastic cap or their finger helps them talk. Alternately, special valves can be attached to the tracheostomy tube. While still taking in air through the tube, these valves allow air to exit the mouth and nose, allowing you to speak. However, not everyone will be able to tolerate a tracheostomy cap, finger occlusion, or a speaking valve. Your healthcare team will provide guidance on how to care for your tracheostomy tube so that you can safely maintain it at home. That includes caring for, cleaning, and replacing the tube as well as keeping the skin around the tracheostomy clean and dry. Cleaning and maintaining the tubeThe tracheostomy tube will need to be worn at all times. A tracheostomy tube typically has three parts:
Most tracheostomy tubes need to be replaced every 1 to 3 months. A respiratory therapist, otolaryngologist (ear, nose, and throat doctor), or another specialist may replace the tube the first time. You and your caregivers can be trained to change the tube. In pediatric tracheostomy If you have trouble coughing up mucus in your lungs or find it hard to breathe, suction can be used to clear your airway. Keeping the stoma cleanWith clean hands, check your stoma at least once a day for symptoms of infection. That can include swelling, redness, or new or bad-smelling discharge. If you notice any of these symptoms, reach out to your doctor. Keep your stoma clean by following these steps:
Activities after the procedureYour recovery from surgery will be a multi-step process. Daily livingSome people with tracheostomies have difficulty speaking. Keeping a pen and paper or whiteboard close by can help with communication. Many people with tracheostomies can eat without trouble, but some may require help from a speech therapist or nutritionist to relearn how to chew and swallow. It may take some time to adjust to sleeping with a tracheostomy. A humidifier can help. If you have severe obstructive sleep apnea and cannot tolerate a continuous positive airway pressure (CPAP) machine or other surgeries, you may actually sleep better with a tracheostomy. HygieneWhile showering, take steps to keep water from getting into the stoma and tracheostomy tube. That can include:
You can also opt for baths instead. Physical activitySlowly increase your physical activity over time. Avoid swimming and situations where you may be submerged in water. If the condition that prompted your tracheostomy has resolved, the tube may be removed. Reasons your doctor may recommend removing your tracheostomy tube include the following:
Before removing your tube, your doctor will first ensure that it’s safe to do so. You’ll likely undergo a capping trial. In a capping trial, you cover the tracheostomy tube with a small cap for increasing periods of time while you’re awake. If it’s easy for you to breathe through your mouth and nose while you wear the cap, then it’s safe for your doctor to remove your tracheostomy tube. Children who undergo a capping trial will often undergo a capping sleep study too and receive a direct laryngoscopy and bronchoscopy. If your tracheostomy is temporary, there’s typically only a small scar left when the tube is removed. If you have a short-term tracheostomy, the stoma will likely close on its own. A long-term tracheostomy may leave a tracheocutaneous fistula that doesn’t close completely. Those with a permanent tracheostomy will require surgical revision to close the stoma. Read this article in Spanish. Last medically reviewed on March 18, 2022 Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Apr 30, 2022 By Brian Krans, Brittany Patterson Mar 18, 2022 Medically Reviewed By Nicole Aaronson, MD, MBA, CPE, FACS, FAAP |