A tracheostomy (TRA-ke-OS-to-me) is a surgically made hole that goes through the front of your neck and into your trachea (TRA-ke-ah), or windpipe. The hole is made to help you breathe.
A tracheostomy usually is temporary, although you can have one long term or even permanently. How long you have a tracheostomy depends on the condition that required you to get it and your overall health.
To understand how a tracheostomy works, it helps to understand how your airways work. The airways carry oxygen-rich air to your lungs. They also carry carbon dioxide, a waste gas, out of your lungs.
The airways include your:
- Nose and linked air passages (called nasal cavities)
- Larynx (LAR-ingks), or voice box
- Trachea, or windpipe
- Tubes called bronchial tubes or bronchi, and their branches
Air enters your body through your nose or mouth. The air travels through your voice box and down your windpipe.
The windpipe splits into two bronchi that enter your lungs. (For more information, go to the Health Topics How the Lungs Work article.)
A tracheostomy provides another way for oxygen-rich air to reach your lungs, besides going through your nose or mouth.
A breathing tube, also called a trach (trake) tube, is put through the tracheostomy and directly into the windpipe to help you breathe.
Doctors use tracheostomies for many reasons. One common reason is to help people who need to be on ventilators (VEN-til-a-tors) for more than a couple of weeks.
Ventilators are machines that support breathing. If you have a tracheostomy, the trach tube connects to the ventilator.
People who have conditions that interfere with coughing or block the upper airways also may need tracheostomies.
Coughing is a natural reflex that protects the lungs. It helps clear mucus (a slimy substance) and bacteria from the airways. A trach tube can be used to help remove, or suction, mucus from the airways.
Doctors also might recommend tracheostomies for people who have swallowing problems due to strokes or other conditions.
Creating a tracheostomy is a fairly common, simple procedure. It’s one of the most common procedures for critical care patients in hospitals.
The windpipe is located almost directly under the skin of the neck. So, a surgeon often can create a tracheostomy quickly and easily.
The procedure usually is done in a hospital operating room. However, it also can be safely done at a patient’s bedside.
Less often, a doctor or emergency medical technician may do the procedure in a life-threatening situation, such as at the scene of an accident or other emergency.
As with any surgery, complications can occur, such as bleeding, infection, and other serious problems. The risks often can be reduced with proper care and handling of the tracheostomy and the tubes and other related supplies.
Some people continue to need tracheostomies even after they leave the hospital. Hospital staff will teach patients and their families or caregivers how to properly care for their tracheostomies at home.
Types of Tracheostomy Tubes
A tracheostomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in the neck and windpipe (Trachea)).
There are different types of tracheostomy tubes that vary in certain features for different purposes. These are manufactured by different companies.
However, a specific type of tracheostomy tube will be the same no matter which company manufactures them.
A commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate), inner cannula, and an obturator.
The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap around the neck.
The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning.
The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted.
There are different types of tracheostomy tubes available and the patient should be given the tube that best suits his/her needs.
The frequency of these tube changes will depend on the type of tube and may possibly alter during the winter or summer months. Practitioners should refer to specialist practitioners and/or the manufacturers for advice.
Who Needs a Tracheostomy?
People of all ages may need tracheostomies for various reasons.
People Who Are on Ventilators
A common reason for needing a tracheostomy is the use of a ventilator (VEN-til-a-tor) for more than a couple of weeks.
A ventilator is a machine that supports breathing. It’s connected to a tube that is put through the tracheostomy. This tube often is called a trach tube. The tube carries oxygen-rich air from the ventilator to the lungs.
For people who are on ventilators and awake, a trach tube might be more comfortable than a breathing tube put through the nose or mouth and down into the windpipe.
A trach tube also makes it possible for some people who are on ventilators to eat and talk.
Depending on your reason for needing a ventilator, your tracheostomy might be temporary or permanent. If you need a ventilator for the rest of your life, your tracheostomy will likely be permanent.
If your doctor decides that you can stop using the ventilator, you may no longer need the tracheostomy. You can then let the hole close up, either on its own or with surgery.
People Who Have Conditions That Affect Coughing or Block the Airways
Your doctor might recommend a tracheostomy if you have trouble coughing. Coughing is a natural reflex that protects your lungs.
It helps clear mucus and bacteria from your airways. If you have trouble coughing, a trach tube can help suction mucus from your airways.
Your doctor also might recommend a tracheostomy if you have a condition that obstructs, or blocks, your upper airways.
Examples of diseases, conditions, and other factors that might interfere with coughing or block your upper airways include:
- Congenital defects of the upper airways (in children). “Congenital” means that the defects are present at birth.
- Airway injuries from smoke, steam, or chemical burns.
- Severe allergic reactions or infections.
- Removal of the larynx (for example, from cancer).
- Long-term coma.
- Neuromuscular diseases that paralyze or weaken the muscles and nerves involved in breathing.
- Spinal cord injuries.
Some of these conditions are temporary. Once you recover enough to breathe easily and safely on your own, you may no longer need the tracheostomy.
Other conditions may require you to have a tracheostomy long term or even permanently.
People Who Have Swallowing Problems
Your doctor may recommend a tracheostomy if you have trouble swallowing due to a stroke or other condition. You may need the tracheostomy until you can swallow normally again.
What To Expect Before a Tracheostomy
The procedure to make a tracheostomy usually is done in a hospital operating room. However, it also can be safely done at a patient’s bedside.
Rarely, a doctor or emergency medical technician will do the procedure in a life-threatening situation, such as at the scene of an accident or other emergency.
When the procedure is done in a hospital, a general or pediatric surgeon or an otolaryngologist does the surgery.
Otolaryngologists specialize in diagnosing and treating problems with the ears, nose, and throat and related structures of the head. These doctors also are called ear, nose, and throat (ENT) doctors.
A pulmonologist or intensive care doctor may help assess your need for a tracheostomy. A pulmonologist specializes in diagnosing and treating lung diseases and conditions.
Often, doctors have to create tracheostomies on short notice, so you have little time to prepare. When possible, the surgical team may request that you fast (not eat anything) for 6–8 hours before the surgery.
If you’re having a tracheostomy procedure, you’ll receive general or local anesthesia (AN-es-THE-ze-ah). The term “anesthesia” refers to a loss of feeling and awareness.
General anesthesia temporarily puts you to sleep. Local anesthesia numbs the neck and surrounding area.
What To Expect During a Tracheostomy
To create a tracheostomy, your surgeon will make a cut through the lower front part of your neck. He or she will then make a cut in your trachea, or windpipe.
The surgeon will place a tube (called a trach tube) through the hole and into the windpipe. The tube will help keep the hole open. Some trach tubes are “cuffed.”
Doctors can widen or narrow cuffed tubes by inflating or deflating them with air.
You may have a chest x ray to ensure the trach tube is placed correctly. The tube will then be held in place with stitches, surgical tape, or a Velcro band.
The procedure to make a tracheostomy usually takes between 20 and 45 minutes.
What To Expect After a Tracheostomy
Depending on your overall health, you may stay in the hospital for 3–10 days or more after getting a tracheostomy. It can take up to 2 weeks for a tracheostomy to fully form, or mature.
You might be sedated during your recovery. This means that you’ll be given medicine to help you relax. The medicine might make you sleepy.
Until the tracheostomy is mature, you won’t be able to eat normally. Instead of food, you may receive nutrients through an intravenous (IV) line inserted into a vein in your body. Or, you may get food through a feeding tube.
The feeding tube is placed through your nose or mouth and guided to your stomach.
If you’ll be on a ventilator for a long time, the tube might be placed directly into your stomach or small intestine through a surgically made hole.
After the tracheostomy has matured, you’ll likely work with a speech therapist to regain your ability to swallow normally.
You may have swallowing tests to show whether you can swallow safely. If you can, you might be able to start eating normally again.
You won’t be able to talk right after the procedure. Even after the tracheostomy has matured, you’ll still have trouble speaking.
The trach tube interferes with the normal voice process. It prevents air from the lungs from flowing over the voice box.
However, once your tracheostomy has matured, a speech therapist or other health professional will show you ways in which you can use your voice to speak clearly.
One option is a speaking valve that attaches to the trach tube. The valve lets air enter the tracheostomy, pass into the windpipe and up over the voice box, and then exit the mouth or nose.
Certain types of cuffed trach tubes also can help you speak. Doctors can widen or narrow cuffed tubes by inflating or deflating the cuffed part with air.
If you’re using a ventilator, for example, the cuffed tube is inflated to fill the width of the airway. If you aren’t using a ventilator, the tube can be deflated. This allows some air to enter the windpipe and pass over the voice box.
If you no longer need the tracheostomy, your doctor will remove your trach tube. The hole should close up on its own fairly quickly.
If the hole doesn’t close on its own, you may need surgery to close it. A small scar will remain at the site of the tracheostomy.
What Are the Risks of a Tracheostomy?
As with any surgery, a tracheostomy procedure can cause complications. Some complications are more likely to occur soon after the procedure is done. Others are more likely to happen over time.
Some complications are related to the tube that is put through the tracheostomy into the windpipe (the trach tube).
Proper care and handling of the tracheostomy and the tubes and other related supplies can help reduce risks.
Complications that can occur shortly after surgery include:
Bleeding and infection.
Pneumothorax (noo-mo-THOR-aks). This is a condition in which air or gas builds up in the space between the lungs and chest wall. Pneumothorax can cause sudden pain in one side of the lung and shortness of breath.
The condition also can put pressure on the lung and cause it to collapse.
Subcutaneous emphysema (sub-ku-TA-ne-us em-fi-SE-ma). This is a condition in which air gets trapped beneath the skin.
Over time, other complications can develop. For example, infections may scar the windpipe. A fistula (FIS-tu-lah), or abnormal connection, may form between the windpipe and esophagus.
(The esophagus is the passage leading from your mouth to your stomach.)
A fistula between the windpipe and esophagus can cause food and saliva to enter the lungs and possibly cause pneumonia. Symptoms of a fistula include severe coughing and trouble breathing.
Trach Tube Complications
Some complications are related to the trach tube. For example, the tube may slip or fall out of the tracheostomy. Other problems include:
- Abnormal tissue masses, or granulations (GRAN-u-LA-shuns), in the airways
- Narrowing or collapse of the airway above the trach tube’s location
- Irritation of the windpipe’s inside lining from the tube rubbing against the lining’s surface
- Blockage of the tracheostomy from dried secretions and mucus masses (also called plugs)
- Failure of the tracheostomy to close on its own after the trach tube is removed