Tracheostomy

(Also called a "trach," pronounced trake)

Procedure overview

Normally when you breathe, the air comes into your mouth or nose. Then it goes down through a tube called the trachea (windpipe) and into your lungs. During a tracheostomy, a surgeon creates a hole in the front of the neck. This allows air to go through a tube put into the windpipe instead of through your nose or mouth.

Reasons for the procedure

A tracheostomy may be permanent, or it may be needed only for a while. Surgeons do this procedure for many reasons:

• Most often, people have a tracheostomy because they are going to need a breathing machine called a ventilator for more than a few weeks. A ventilator blows air into the lungs through the tube put into the tracheostomy hole. This may be better for you than putting the tube through the mouth or nose.

• Some people need a tracheostomy because their airway is blocked, or because they can't clear mucus from their airways by coughing. These problems may be because of issues such as birth defects, injuries, or surgery to remove a structure called the larynx (voice box).

• Some people need this procedure because they can't swallow properly, such as after a stroke.

Risks of the procedure

A tracheostomy may put you at risk for certain problems shortly after the surgery or over the long term, such as:

• Bleeding or infection

• Nerve damage

• A buildup of gas between a lung and your chest wall, called a pneumothorax. This can lead to a collapsed lung.

• Formation of a fistula or connection between the trachea and the esophagus—the tube that takes food and liquid from your mouth to your stomach

• Changes in the airway such as scar tissue or narrowing in the trachea

• Irritation of the lining of the windpipe caused by the tracheostomy tube; the tracheostomy tube may also come loose

• Failure of the hole to close on its own once you stop using the tracheostomy tube (if the tracheostomy is temporary)

• Scarring after the tracheostomy hole is allowed to close and has healed (if the tracheostomy is temporary)

There may be other risks, depending upon your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

Before the procedure

Sometimes the doctor will perform a tracheostomy because of an emergency. If you have time to prepare for the procedure, you may need to avoid eating for at least several hours beforehand.

A health care provider will give you local anesthesia—to keep you from feeling the procedure—or general anesthesia, to put you to sleep during the procedure.

During the procedure

The doctor will create the small tracheostomy hole just above where your collarbones meet at the top of your chest. The procedure should take about 20 to 45 minutes. Afterward, the doctor will place a tube into the hole to keep it open and allow air to pass through it.

After the procedure

Your health care team may give you medicine to make you feel relaxed after the procedure. Depending on the health problem that made you need the tracheostomy, you may need to stay in the hospital for a week or longer.

You may not be able to eat for the first week or two. Instead, you may receive nourishment 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 health care team members may help you with these tasks.

You will also need to use a device to keep your airways moist. 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 health care 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.

Contact your health care provider if you have:

• Mucus that smells bad or mucus containing bright red blood coming from the tracheostomy

• A change in the amount or color of mucus coming from the opening

• Inflamed skin around the opening

• A fever of 101 degrees or more

If you have a blockage and continue to have difficulty breathing after following steps provided by your health care provider, call 911.

Reviewed Date: 01-06-2011