What is Tracheostomy

Tracheostomy is a procedure to create an opening in the windpipe (trachea). A breathing tube (tracheostomy tube) is then placed in this opening. This allows you to breathe without using your nose or mouth.

A tracheostomy may be permanent or temporary. It may be planned and performed in an operating room, or it may be an emergency procedure performed at your hospital bedside or in an emergency room.

You may need to have a tracheostomy if:

• You need long-term help with breathing (ventilation).
• Your airway is blocked by:
  • Swelling.
  • Injury.
  • Tumor.
  • A foreign object.
  • A vocal cord problem.
  • Severe narrowing of the trachea.
• You have too much mucus or other fluids (secretions) in your airway that need to be suctioned often.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Puncture of one or both lungs (pneumothorax).
• Narrowing of the trachea, making it hard to breathe.
• Damage to the gland in the lower front part of the neck (thyroid gland).

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one of the following:
  • A medicine to numb the area (local anesthetic).
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• The front of your neck will be cleaned with a germ-killing solution (antiseptic).
• An incision will be made below your Adam’s apple.
• Muscles in your neck will be separated to reach the front of your trachea.
• An incision or a small hole will be made in the front wall of your trachea.
• A tracheostomy tube will be put through the opening.
• A thin, flexible tool with a camera on it (bronchoscope) may be used to make sure the tracheostomy tube is in the right place.
• A balloon (cuff) at the end of the tracheostomy tube will be inflated. When the cuff is inflated, the air you breathe will flow in and out of the tracheostomy tube, and not your mouth and nose.
• The tracheostomy tube will be tied or stitched (sutured) in place.
• The incision in your neck will be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• If you need breathing help, your tracheostomy tube will be connected to a breathing machine (ventilator).
• Your tracheostomy opening may be suctioned and cleaned frequently.
• You and your caregivers will learn how to care for your tracheostomy, including how to:
  • Clean your tracheostomy opening.
  • Change the tube.
  • Communicate.
  • Safely suction secretions.
  • Protect your lungs.
• Do not drive for 24 hours if you were given a sedative during your procedure.

Summary

• A tracheostomy is a procedure to create an opening in the windpipe (trachea).
• A tracheostomy may be permanent or temporary.
• You may need to have a tracheostomy if you need long-term breathing assistance (ventilation).
• During the procedure, an incision will be made in the front wall of your trachea, and a tracheostomy tube will be put through the opening.

Tracheostomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Crusting and slight bleeding around the tracheostomy opening.
• Inability to speak with your normal voice.
• Increased coughing with mucus.
• Limited sense of smell and taste.

Follow these instructions at home:

Tracheostomy care

• Change your bandage (dressing) as told by your health care provider.
• Wash your hands with soap and water before touching your dressing or any part of your tracheostomy.
• Make sure that you and your caregivers know how to:
  • Clean and replace your breathing tube (tracheostomy tube).
  • Keep your tracheostomy opening free of mucus.
  • Suction your windpipe (trachea).
  • Care for the skin around your tracheostomy opening.
• Protect your trachea and lungs from dry air. To do this:
  • Cover the opening of your tracheostomy tube with moist gauze or a rubber collar (stoma bib or shower shield), as recommended by your health care provider.
  • Use a humidifier in your home to add moisture to the air.
• When you change the tracheostomy holder around your neck, make sure that you can fit two fingers between the holder and your neck.
• Always have supplies available for tracheostomy care.

Eating and drinking

• Follow instructions from your health care provider about any eating or drinking restrictions.
• Try adding spices and herbs to foods to improve flavor.
• Drink enough fluids to keep your urine pale yellow and to keep your mucus moist.

Activity

• Avoid activities that require a lot of energy (strenuous activities) for 2 weeks, or as long as told by your health care provider. Ask your health care provider what activities are safe for you and when you may return to your normal activities.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.

General instructions

• Keep water out of your tracheostomy tube.
  • When you take a bath or shower, cover your tracheostomy tube with a shower shield, as told by your health care provider.
  • Do not swim.
• Work with a speech therapist to find the best way for you to communicate. There are many options for communicating with a tracheostomy.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay incision healing and make it harder to breathe. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear a medical alert bracelet or necklace that says that you have a tracheostomy.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• A fever or chills.
• A cough that does not go away and produces more mucus.
• Increased crusting, bleeding, or irritation around your tracheostomy opening.
• Mucus that smells bad or is discolored.
• Questions about how to care for your tracheostomy.

Get help right away if:

• You have trouble breathing.
• Your tracheal tube comes out and you cannot replace it.
• You have persistent bleeding or unusual drainage from your tracheostomy opening.
• You start to choke after eating.

Summary

• After a tracheostomy, it is common to have crusting and slight bleeding around the tracheostomy opening.
• Make sure that you and your caregivers know how to clean and replace your breathing tube (tracheostomy tube).
• Keep water out of your tracheostomy tube. When you take a bath or shower, cover your tracheostomy tube with a shower shield, as told by your health care provider.
• Get help right away if you have trouble breathing.