Tracheostomy Procedure – Healthnile.com

Overview

A tracheostomy is a medical alteration where a hole forms in the front of the neck, leading directly into the windpipe (trachea). This opening provides an alternate path for air to reach the lungs, especially if the usual breathing route is blocked or restricted.

Key Features:

Tracheostomy Tube: Doctors insert this tube into the new opening to support airflow.
Purpose: Medical teams use it for people needing long-term support from a ventilator or those facing temporary airway blockages.
Emergency Use: Surgeons may perform it quickly if the airway becomes blocked due to a serious injury.

Structure	Description
Windpipe (Trachea)	Main passage for air to move from the throat to the lungs
Lungs	Organs that receive air through the tracheostomy and perform gas exchange
Esophagus	Located behind the trachea; not directly involved, but surgeons are careful to avoid it

Some tracheostomies are only temporary. After patients no longer need them, the opening may heal on its own or a doctor may close it. In certain cases, the opening and tube remain in place permanently to support breathing needs.

Reasons Tracheostomies Are Performed

Immediate Airway Access in Critical Situations

In emergencies, a tracheostomy gives fast access to the airway when breathing through the mouth or nose is not possible. This can happen after severe injuries to the head or neck, swelling, or when other emergency airway steps do not work. Trained medical teams may perform this procedure outside the hospital if waiting for transport would be too risky.

Key Emergency Situations

Serious trauma to the neck or face
Blockage from swelling, tumors, or blood
Complications that make placing a standard breathing tube impossible

Sometimes, first responders perform a cricothyrotomy at the accident scene instead of a tracheostomy. This creates a hole just below the Adam’s apple, allowing air to reach the lungs quickly. Cricothyrotomy is faster and requires less equipment, but is best only as a temporary solution.

How It Helps

Provides an open airway for oxygen delivery
Allows easy suctioning of mucus when breathing is blocked
Makes it possible to connect to a ventilator or breathing machine for oxygen support

Comparing Emergency Airway Procedures

Procedure	Location on neck	When used	Main purpose	Typical outcome
Tracheostomy	Below voice box (larynx)	Planned or emergency	Long-term airway support	Ongoing breathing help
Cricothyrotomy	Just under Adam’s apple	Emergency	Short-term airway access	Temporary until stable

Possible Risks

Tracheostomy procedures can bring several risks that vary by when they occur and how long the tube is in place. Some risks appear right after surgery, while others develop over time.

Common Immediate Risks

Bleeding: This may happen at the wound site or from the windpipe itself. Heavy bleeding can be serious if not managed quickly.
Damage to Nearby Tissues: The surgery may cause harm to the windpipe, thyroid gland, or nerves in the neck.
Misplacement of the Tube: The tracheostomy tube might not be positioned correctly, or it can move from its spot, leading to breathing issues.
Air Leaks: Air can become trapped under the skin of the neck. This is called subcutaneous emphysema, and it may make breathing harder or harm the windpipe or food pipe.
Lung Complications: In rare cases, air may gather between the chest wall and the lung (pneumothorax), which may lead to pain, shortness of breath, or a collapsed lung.
Blood Clots or Collections: Blood may pool in the neck and push against the windpipe, further blocking airflow.

Longer-Term Risks

Tube Blockage: Mucus may build up in the tube, increasing the risk of blocked airways and difficulty in breathing.
Infections: Both the area around the tracheostomy and the respiratory tract can become infected. This includes infections such as tracheobronchitis or pneumonia.
Tube Displacement: The tube can shift out of the windpipe, which can make breathing less effective.
Windpipe Changes: Scarring or narrowing of the windpipe may occur after some time with the tube in place.
Unusual Passages: Rarely, passages can develop between the windpipe and the esophagus or large blood vessels. If this happens, it can lead to serious conditions, such as food or fluids entering the lungs or heavy, life-threatening bleeding.

When to Seek Help

Attend regular medical appointments to monitor for problems. Report any sudden change in breathing, bleeding at the site, pain, skin color changes, swelling, or tube movement to a healthcare provider.

Risk Type	What Can Happen
Bleeding	Blood at site or from airway
Mucus Blockage	Tube blocked, breathing may become difficult
Infection	Redness, pain, fever, or cough may occur
Tube Displacement	Tube moves out, less effective breathing

Getting Ready

Before the tracheostomy, the care team explains that you might need to avoid food and drinks for several hours, especially if anesthesia will be used. The care team gives direct instructions if you need to pause certain medications.

For a hospital stay, pack comfortable clothes like pajamas, a robe, and slippers. Bring personal hygiene items such as a toothbrush, shaving gear, and other daily items. Entertainment ideas include books, magazines, or handheld games to make the stay more pleasant.

Since you may not be able to talk right after a tracheostomy, bring communication tools such as a whiteboard with a marker, a notepad and pen, a smartphone, or a small computer. The care team often gives guidance on ways to stay in touch while recovering.

What You Should Know About the Process

Steps Taken During the Surgery

Before the procedure, most patients receive general anesthesia to help them sleep and not feel pain. In certain urgent cases or if needed, a local anesthetic may numb the neck, allowing the person to be comfortable while awake or lightly sedated. There are two main approaches to forming a new airway:

1. Standard Surgical Method

The healthcare provider makes a horizontal cut at the lower part of the neck.
The surgeon moves muscles aside and may separate a portion of the thyroid gland.
The surgeon creates a small opening (stoma) into the windpipe, or trachea.
The surgeon inserts a tracheostomy tube into this opening to allow breathing.
The team holds the tube in place using a neck strap and sometimes with temporary stitches.

2. Minimally Invasive Technique

The surgeon makes a small cut at the front base of the neck.
The team uses a special viewing device through the mouth to guide the surgeon.
The surgeon places a needle into the trachea under direct vision and expands the opening for the tube.
The team often performs this method at the patient’s bedside in the hospital.

Comparison	Surgical Tracheostomy	Minimally Invasive Tracheostomy
Where performed	Operating room or hospital room	Usually hospital room (bedside)
Anesthesia used	General or local	Mostly local with light sedation
Main difference	Larger incision, direct vision	Guided by scope, smaller incision

A tracheostomy tube, or trach tube, is inserted into the airway and secured with a strap and sometimes stitches. Tubes may be cuffed to help prevent air leaks and protect the airway. Some tubes have an inner cannula that can be removed for cleaning.

What Happens After Surgery

After getting a tracheostomy, patients usually stay in the hospital for a few days. Recovery includes learning how to take care of the new airway, manage the tube, and get used to changes in breathing and daily tasks.

Key Areas Covered in Recovery

Caring for the Tube: Nurses teach patients or caregivers how to clean the tracheostomy tube, change the tube when needed, and keep the stoma (opening) clean to reduce infection risk.
Speaking: With a tracheal tube in place, speaking can be hard because air often does not pass through the vocal cords. Special devices or techniques might help air reach the voice box so the person can talk. The ability to speak depends on the tube type, trachea width, and voice box condition. Speech therapists offer support in regaining speech.
Eating and Swallowing: Right after surgery, swallowing may be tough, so nurses give nutrients through an IV, feeding tube, or directly into the stomach. When ready, a speech therapist may help the patient learn or re-learn to swallow safely.
Breathing Drier Air: The tracheostomy bypasses the nose and mouth, so the air entering the lungs is not moistened as usual. This can make the airway dry and uncomfortable, leading to coughing and thicker mucus. To help:
- Nurses may add small amounts of saline to the tube to loosen mucus.
- A heat and moisture exchanger or a humidifier can help moisten inhaled air.
- Staff may use saline nebulizer treatments as directed.
Clearing the Airway: Extra mucus may need to be removed with a suction machine. Nurses train patients or caregivers to use suction safely to keep the airway clear and lower the risk of complications.

Tips for Home Care

Wash hands before caring for the stoma or tube.
Keep the area around the stoma dry and clean.
Ensure supplies are always ready, including spare trach tubes, suction equipment, and cleaning materials.
Follow the care team’s advice about changing dressings and cleaning the inner cannula.
Watch for increased redness, swelling, pain, or bleeding at the site.

Possible Effects to Watch For

Effect	Description	What to Do
Extra mucus	More frequent suction needed	Use suction machine as trained
Dryness/cough	Stoma may feel dry, more coughing	Use humidifiers/moisture exchange
Difficulty speaking	May not be able to talk at first	Practice with therapists; use devices
Infection risk	Redness, swelling, discharge at stoma	Call healthcare team if concerned
Blockage	Tube may get plugged by mucus	Clean tube/inner cannula as shown

Tracheostomy Recovery Process

After a tracheostomy, most people use the tube for a limited time until their breathing improves. In some situations, the tube may stay in place as a long-term solution if breathing problems continue.

The care team often uses heat and moisture exchangers to help keep airways comfortable. Caregivers usually clean the area with hydrogen peroxide to safely disinfect it.

Healing Steps

The healthcare team removes the tube when appropriate.
The opening might close by itself.
Sometimes, a doctor closes the opening.