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Tracheostomy

Tracheostomy

(Also called a "trach," pronounced trake)

Procedure overview

When you breathe, air comes in through your mouth or nose. It then flows down a tube in your throat called the trachea and into your lungs. But in some cases, a person can’t breathe this way. When that happens, a tracheostomy can be done to help the person breathe. A tracheostomy is also known as a trach, which is pronounced “trake.” During a tracheostomy, a doctor creates a small hole in the lower part of the front of the neck. A small tube is put into the hole. A manual airbag or breathing machine is connected to the tube. This allows air to go straight into the trachea instead of first going through the nose or mouth. 

Why is a tracheostomy done?

You may need a trach because your airway is blocked because of sudden trauma or infection. Some people need it because they can't swallow normally, such as after a stroke. They may not be able to clear mucus from their airways by coughing. These problems may be because of issues such as birth defects or injuries. Or they may be because of surgery to remove the voice box (larynx).

Most often, a person has a tracheostomy because he or she needs a breathing machine (ventilator) for a few weeks or more. A ventilator blows air into the lungs through the tube put into the trach hole. Using a trach may prevent damage to the upper airway or vocal cords caused by putting an air tube through the mouth or nose for a long time.

If the tracheostomy is done in an emergency, the hole may be needed only for a short while. But in some cases, it may be needed permanently.

Risks of the procedure

Like any surgery, tracheostomy has some risks. These include:

  • Bleeding or infection

  • Nerve damage

  • A buildup of air between a lung and your chest wall (pneumothorax) that can lead to a collapsed lung

  • An abnormal connection (fistula) between the trachea and the tube that takes food and liquid from your mouth to your stomach (esophagus)

  • Irritation of the lining of the windpipe

  • Failure of the hole to close after the tracheostomy tube is no longer needed

  • Scar on the neck 

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

Emergency tracheostomy

In some cases, a tracheostomy is done in an emergency. You may not have time to prepare. Or you may not be conscious. It may be done at the bedside in your hospital room at a moment's notice. Sometimes a tracheostomy needs to be done when a person is not in a hospital. It may be done at the scene of an accident, in the grocery store, or at home.

In these cases, when possible, the person is given local anesthesia on the neck to prevent pain. The neck area is cleaned. A cut is made in the lower front part of the neck. A thin tube is put in the hole. A manual airbag attached to an oxygen supply is connected to the tube. When the bag is squeezed, air goes into the person's lungs.

Long-term tracheostomy

For other kinds of tracheostomy, you will have time to prepare.

Before the procedure

  1. You will be told not to eat or drink for several hours before the procedure.

  2. You will be asked to remove any jewelry.

  3. If you are not already in a hospital gown, you will be asked to change into a hospital gown.

  4. You will lie down on a surgical table.

  5. Your heart rate, blood pressure, breathing rate, and oxygen level will be watched and recorded before and during the procedure.

  6. You may be given extra oxygen as needed through a face mask or nasal tube.

  7. To prevent pain, you will be given local anesthesia. Or you may be given general anesthesia. This puts you in a state like deep sleep during the procedure.

During the procedure

  1. The procedure should take about 20 to 45 minutes.

  2. The skin on your neck is cleaned with an antiseptic solution.

  3. The doctor cuts through the skin in the lower part of the front of your neck.

  4. The thyroid gland is pushed out of the way. In some cases it may be cut.

  5. The doctor makes a cut in the trachea.

  6. Afterward, the doctor will place a tube into the hole to keep it open and allow air to pass through it.

  7. The doctor will use stitches (sutures) to keep the tube (cannula) in place.

After the procedure

  1. Your health care team may give you medicine to make you feel relaxed after the procedure.

  2. Depending why you need the trach, you may need to stay in the hospital for a week or more.

  3. If your trach is temporary, once the tube is removed you’ll be given instructions for how to care for the wound.

  4. The hole should heal in a few days.

Caring for a long-term tracheostomy

If your trach is needed for a longer period of time, you’ll be given instructions for how to manage and care for it.

You may not be able to eat by mouth for the first week or two. Instead, you may receive nutrition 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 may also need to use a device to keep your airway moist, particularly if you are receiving oxygen through a tube. 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.

When to call your doctor

Contact your health care provider if you have:

  • Mucus that smells bad

  • Mucus containing bright red blood coming from the tracheostomy

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

  • Sore, red skin around the trach opening

  • A fever of 101°F (38.3°C) or more

Call 911 right away if you have a blockage and can’t breathe.

Reviewed Date: 08-21-2013


Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.