What is Tracheostomy? Purpose, Procedure & Recovery

A tracheostomy is a surgical procedure that creates a small opening in the front of your neck to help you breathe. This opening connects directly to your trachea (windpipe), bypassing your mouth and nose. While it might sound overwhelming at first, this procedure can be life-saving and often temporary, giving your body the breathing support it needs during recovery.

What is a tracheostomy?

A tracheostomy creates a direct pathway for air to reach your lungs through a small hole in your neck. During the procedure, a surgeon makes a carefully placed incision in your trachea and inserts a special tube called a tracheostomy tube or "trach tube."

This tube acts like a new breathing route that completely bypasses your upper airway. Think of it as creating an alternative entrance to your breathing system when the usual path through your nose and mouth isn't working well enough.

The opening itself is called a stoma, and it's typically about the size of a dime. Many people live comfortably with a tracheostomy, and in many cases, it can be reversed once the underlying condition improves.

Why is a tracheostomy done?

Doctors recommend a tracheostomy when you need long-term breathing support or when your upper airway is blocked or damaged. This procedure can be planned ahead of time or performed in emergency situations when immediate breathing help is needed.

The most common reasons include prolonged mechanical ventilation, severe throat or neck injuries, and certain medical conditions that affect breathing. Let's look at the specific situations where this procedure becomes necessary.

Here are the main medical situations that might require a tracheostomy:

• Prolonged mechanical ventilation (usually after 7-10 days on a breathing machine)
• Severe throat or laryngeal swelling from infection or injury
• Head or neck cancers that block the airway
• Severe facial or neck trauma from accidents
• Neurological conditions affecting breathing muscles
• Congenital airway abnormalities in infants
• Severe sleep apnea that doesn't respond to other treatments
• Vocal cord paralysis affecting both sides
• Severe burns around the face and neck area

Each situation is carefully evaluated by your medical team to determine if a tracheostomy is the best option for your specific needs. The goal is always to ensure you can breathe safely and comfortably.

What is the procedure for a tracheostomy?

A tracheostomy can be performed in an operating room or at your bedside in the intensive care unit. The procedure typically takes 20-45 minutes, depending on your specific situation and whether it's planned or performed as an emergency.

Your surgeon will use either general anesthesia (if you're not already on a ventilator) or local anesthesia with sedation. The choice depends on your current condition and breathing status.

Here's what happens during the procedure:

1. Your neck area is cleaned and draped with sterile coverings
2. The surgeon makes a small horizontal incision in the lower part of your neck
3. Muscles and tissues are gently separated to reach the trachea
4. A small opening is created in the trachea, usually between the 2nd and 4th tracheal rings
5. The tracheostomy tube is inserted through this opening
6. The tube is secured in place with sutures and ties around your neck
7. The incision around the tube is closed with stitches

After the procedure, you'll be monitored closely to ensure the tube is working properly and you're breathing comfortably. Most people adapt to breathing through the tracheostomy tube within a few hours.

How to prepare for your tracheostomy?

If your tracheostomy is planned rather than performed as an emergency, your medical team will walk you through specific preparation steps. The preparation process helps ensure the safest possible procedure and the best recovery outcomes.

Your doctor will review your medical history, current medications, and perform necessary tests before the procedure. Blood tests and imaging studies may be needed to plan the exact placement of your tracheostomy.

Here's what you can expect in the preparation phase:

• Blood tests to check your clotting function and overall health
• Chest X-ray or CT scan to evaluate your airway and neck anatomy
• Discussion about stopping certain medications like blood thinners
• Consent process where all risks and benefits are explained
• NPO status (nothing by mouth) for several hours before the procedure
• IV line placement for medications and fluids
• Positioning and monitoring equipment setup

If you're already on a ventilator, much of this preparation may already be in place. Your medical team will ensure you're as stable as possible before proceeding with the surgery.

How to read your tracheostomy care?

Understanding your tracheostomy care involves learning about the different parts of your tube and recognizing signs that everything is working properly. Your tracheostomy tube has several components that work together to keep your airway open and secure.

The outer tube stays in place and provides the main airway, while the inner tube can be removed for cleaning. Many tubes also have a balloon (called a cuff) that can be inflated to seal the airway when needed.

Here are the key things to monitor and understand:

• Tube position - should remain centered and secure in the stoma
• Breathing sounds - should be clear and easy through the tube
• Secretion color and amount - clear to white secretions are normal
• Skin around the stoma - should be pink and healing without excessive redness
• Tube ties or holder - should be snug but not too tight
• Cuff pressure (if applicable) - maintained at safe levels by your care team

Your healthcare team will teach you or your family members how to provide basic tracheostomy care, including cleaning and suctioning techniques. This education is crucial for maintaining your health and preventing complications.

How to manage your tracheostomy care?

Managing your tracheostomy involves daily cleaning routines, monitoring for complications, and knowing when to seek help. Good tracheostomy care prevents infections and keeps your breathing comfortable and effective.

The most important aspects of care include keeping the area clean, managing secretions, and ensuring the tube stays properly positioned. Your medical team will provide detailed instructions tailored to your specific type of tracheostomy tube.

Here are the essential daily care tasks:

• Cleaning around the stoma with sterile water or saline solution
• Changing the tracheostomy dressing to keep the area dry
• Suctioning secretions when needed to keep the airway clear
• Cleaning or changing the inner tube as directed
• Checking that tube ties or holders are secure but not too tight
• Monitoring for signs of infection or complications
• Humidifying the air you breathe to prevent drying

Many people successfully manage their tracheostomy care at home with proper training and support. Your healthcare team will ensure you're comfortable with all aspects of care before discharge.

What is the best tracheostomy tube type?

The best tracheostomy tube depends on your specific medical needs, anatomy, and long-term goals. There are several types of tubes available, each designed for different situations and patient needs.

Your doctor will select the most appropriate tube based on factors like whether you need mechanical ventilation, your ability to speak, and how long you'll need the tracheostomy. The tube can often be changed later if your needs change.

Common types of tracheostomy tubes include:

• Cuffed tubes - have an inflatable balloon to seal the airway for ventilation
• Uncuffed tubes - allow air to flow around the tube and through your upper airway
• Fenestrated tubes - have holes that allow airflow through your vocal cords for speaking
• Speaking valves - special attachments that help you talk while breathing through the tube
• Disposable inner tubes - make cleaning easier and reduce infection risk
• Adjustable flange tubes - can be customized for different neck anatomies

Your medical team will work with you to find the tube type that gives you the best combination of safety, comfort, and quality of life. Tubes can be changed as your condition improves or your needs change.

What are the risk factors for tracheostomy complications?

Certain factors can increase your risk of complications with a tracheostomy, though most people do very well with proper care. Understanding these risk factors helps your medical team take extra precautions and monitor you more closely.

Age, overall health status, and the reason for your tracheostomy all play a role in determining your risk level. Most complications are preventable with good care and early recognition of problems.

Factors that may increase your risk include:

• Advanced age (over 65 years)
• Diabetes or other conditions that affect wound healing
• Immunosuppression from medications or illness
• Poor nutrition or low protein levels
• Smoking history or ongoing tobacco use
• Obesity that affects neck anatomy
• Previous neck surgery or radiation therapy
• Bleeding disorders or use of blood-thinning medications
• Chronic lung disease or frequent respiratory infections

Having risk factors doesn't mean you'll definitely have complications, but it does mean your care team will pay extra attention to preventing problems. Many risk factors can be managed or improved with proper medical care.

Is it better to have a temporary or permanent tracheostomy?

Most tracheostomies are intended to be temporary, with the goal of removing the tube once your underlying condition improves. However, some people benefit from a permanent tracheostomy depending on their specific medical situation.

The decision about temporary versus permanent depends on factors like your underlying condition, potential for recovery, and overall health goals. Your medical team will discuss these options with you and your family.

Temporary tracheostomies are preferred when:

• You're recovering from an acute illness or injury
• You need short-term ventilator support
• Swelling or blockage in your upper airway is expected to resolve
• You're recovering from major surgery
• Your neurological condition may improve over time

Permanent tracheostomies may be necessary when:

• You have a progressive neurological condition
• Upper airway reconstruction isn't possible
• You have severe chronic lung disease
• Cancer treatment has permanently affected your airway
• You prefer long-term tracheostomy over other options

Even with a "permanent" tracheostomy, your situation can be reassessed over time, and removal may become possible as your health changes.

What are the possible complications of tracheostomy?

While tracheostomy is generally a safe procedure, like any surgery, it can have complications. Most complications are rare and can be prevented or successfully treated when they do occur.

Complications can happen during the procedure, in the immediate recovery period, or develop over time with long-term use. Your medical team monitors closely for any signs of problems.

Early complications (within the first few days) may include:

• Bleeding from the surgical site
• Infection around the stoma
• Tube displacement or accidental removal
• Pneumothorax (collapsed lung)
• Damage to nearby structures like blood vessels
• Difficulty with tube placement

Late complications (weeks to months later) can include:

• Tracheal stenosis (narrowing of the airway)
• Granulation tissue formation around the stoma
• Tube obstruction from secretions
• Skin breakdown around the stoma
• Difficulty swallowing
• Voice changes
• Tracheoesophageal fistula (rare connection between airway and esophagus)

Most complications can be prevented with proper care and regular monitoring. Your healthcare team will teach you how to recognize warning signs and when to seek immediate help.

When should I see a doctor for tracheostomy concerns?

You should contact your healthcare provider immediately if you notice any signs of complications or if you're having trouble breathing through your tracheostomy. Quick action can prevent minor problems from becoming serious.

Some situations require immediate emergency care, while others can wait for a regular appointment or phone consultation. Learning to recognize the difference is important for your safety.

Seek emergency care immediately if you experience:

• Difficulty breathing or shortness of breath
• Tube displacement or complete blockage
• Heavy bleeding from the stoma
• Chest pain or signs of pneumothorax
• Severe swelling around the neck
• Signs of severe infection like fever and chills
• Inability to speak or swallow suddenly

Contact your doctor within 24 hours for:

• Increased or discolored secretions
• Mild bleeding that doesn't stop with pressure
• Redness or swelling around the stoma
• Tube that seems loose or not positioned correctly
• Persistent cough or changes in your voice
• Skin irritation or breakdown around the tube

Having a good relationship with your healthcare team and understanding when to seek help can make living with a tracheostomy much safer and more comfortable.