Tracheostomy

What is a tracheostomy?

A tracheostomy is an opening a surgeon makes through your neck and into your trachea (windpipe). A tracheostomy tube, or trach (pronounced “trake”), goes through the hole and into your windpipe to help you breathe. The actual procedure to create the tracheostomy (opening) is called a tracheotomy. But most healthcare providers use these terms interchangeably.

A tracheostomy allows you to get air through your neck when you’re having trouble breathing through your mouth and nose. You may need a tracheostomy if you:

• Have a narrowing or a blockage in your airway, and intubation (placing a breathing tube through your nose or mouth) isn’t an option
• Have trouble breathing due to a lung condition, paralysis or an injury to your head and neck
• Need help breathing after surgery on your voice box or throat
• Need to be on a ventilator (breathing machine) for more than a week
• Have a condition that makes it hard to clear mucus out of your airway by coughing (a tracheostomy provides an access route to suction out the mucus and clear your airway)

Depending on your situation, a tracheostomy might be temporary or permanent. It’s usually an elective procedure (one you schedule and prepare for). But sometimes, it’s an emergency treatment.

How should I prepare for this procedure?

Your healthcare provider will tell you how to prepare for an elective tracheostomy. If you’ll be under general anesthesia, you may need to fast or stop taking certain medications for several hours before your appointment.

You’ll also need to pack a suitcase to bring with you. Most people need to stay in the hospital for a few days to a few weeks after surgery. Your provider may tell you to bring:

• Clothes and toiletries. Pack comfortable pajamas and personal hygiene products, like your toothbrush.
• Medications. You’ll need to bring medications or any supplements you’re taking.
• Entertainment. Bringing a book or other forms of entertainment can help pass the time while you’re in recovery.
• Communication devices. You won’t be able to talk immediately after surgery. Bringing a pen and paper, smartphone or tablet can help you communicate with your caregivers and loved ones in the hospital.

What happens during a tracheotomy?

Open tracheotomy surgery takes place in an operating room. First, you’ll likely get general anesthesia so you’re asleep. Once you’re comfortable, your surgeon will create an incision (cut) in your neck, just below your Adam’s apple. This incision will go through the wall of your windpipe. Next, your surgeon will gently widen the opening enough to fit a tracheostomy tube inside.

Once the tube is in place, your surgeon will secure it with a tracheostomy collar that goes around your neck. Your surgeon may also place temporary stitches. This keeps the tube in place during your recovery.

If you’re unable to breathe on your own, your surgeon will hook the tracheostomy tube up to a ventilator.

Percutaneous tracheostomy

A percutaneous tracheostomy is a newer form of the procedure. It often happens at your bedside in the hospital. Instead of making cuts to access your trachea, a surgeon inserts a needle to create a hole in your neck and windpipe. They’ll insert a wire to guide a small plastic tube (catheter) inside that they’ll use to widen the opening.

Then, they’ll insert the tracheostomy tube.

What are the potential benefits and risks of a tracheostomy?

A tracheostomy helps you get air when you’re unable to breathe through your mouth and nose. Compared to intubation, it’s more comfortable. It also helps many people transition from being on a ventilator to breathing on their own.

Still, like any surgical procedure, there are some risks associated with tracheostomy. Possible complications include:

• Bleeding and infection
• Damage to your esophagus or windpipe
• Narrowing of your trachea due to inflammation or scar tissue
• Injury to your recurrent laryngeal nerve (the nerve that moves your vocal cords)
• Mucus or blood clots blocking your tracheostomy tube
• Air getting trapped in your lungs, chest or under the skin around your tracheostomy
• An abnormal opening between your trachea and esophagus (which can allow food or liquids to get into your lungs)

Keeping your tracheostomy tube clean and following your healthcare provider’s instructions can reduce your risk of complications.

What happens after a tracheostomy?

After your tracheostomy, your medical team will watch your progress to ensure a successful recovery. Until you can meet with a speech-language pathologist (SLP), you’ll communicate through writing.

Your healthcare provider will give you instructions before you leave so you know how to take care of yourself and your tracheostomy tube at home.

What is the recovery time?

On average, a tracheostomy takes about two weeks to fully heal. It’s common to feel neck soreness during this time. It may take a day or two to get used to breathing through your trach tube.

If your tracheostomy is temporary, your healthcare provider can remove your trach tube once your airway is open. The removal process is called decannulation. Sometimes, the hole closes on its own within a few weeks. Or you may need a procedure to seal it. Afterward, most people have a tiny scar where their incision was.

Whether your tracheostomy is temporary or permanent, your healthcare provider will give you instructions about adjusting to life with a trach.

Tracheostomy care

Before leaving the hospital, you’ll receive instructions about how to care for your tracheostomy tube at home. Typically, you’ll need to clean your tracheostomy tube at least twice a day. You’ll also need to return to your healthcare provider’s office so they can change out the tube. Your provider will tell you how often your tube will need to be replaced.

Talking

You can speak with a tracheostomy after you’ve had some time to heal, but it’ll take practice. You can speak by covering your tracheostomy hole with a finger and forcing air out through your mouth. A speech-language pathologist (SLP) can teach you how to do this.

There are also speaking valves that can help you talk. These allow you to speak without using your finger to cover your tracheostomy hole.

Be patient with yourself as you try to talk. At first, speaking may make you feel winded. Take your time and use writing instead if you’re feeling exhausted. Ask your SLP about resources or devices that can help you communicate.

Eating

It may take a while to eat and swallow like you’re used to. At first, you may need to receive nutrition through an IV or feeding tube. A speech-language pathologist can teach you exercises to help you swallow so you can eat more comfortably.

Activity

Get as much rest as possible during recovery. Your healthcare provider will tell you how much activity is acceptable. Generally, it’s a good idea to do a brief walk each day. Movement can help keep your lungs clear and prevent constipation. But it’s important not to overexert yourself.

When should I call my healthcare provider?

Contact your healthcare provider right away if you:

• Have trouble breathing
• Develop an irregular heart rate
• Experience severe pain that doesn’t improve with medication
• Develop mucus plugs, crusting or swelling at the surgery site
• Have signs of infection, like a fever or redness, warmth and pus at the surgery site

You should also reach out to your provider if your trach tube changes position or slips out of place.

Is a trach considered life support?

A tracheostomy can be a form of life support. Your surgeon may attach your tracheostomy tube to a ventilator if you can’t breathe on your own. Depending on your situation, a trach may help you transition from using a ventilator to breathing on your own.

You may need a tracheostomy in the short-term, long-term or permanently. But for most people, a trach is temporary.