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Tracheostomy

By

Sarah Lewis, PharmD

What is a tracheostomy?

A tracheostomy is the surgical creation of a stoma (hole) in the front of the neck and through the trachea (windpipe). A tube is usually placed in the opening. The tube provides an airway and access to remove lung secretions and excess mucus. Once the tube is in place, you will breathe through the tube instead of your nose or mouth. A tracheostomy can be temporary or permanent, depending on the condition for which it is needed.

The word tracheostomy is often used interchangeably with tracheotomy. However, tracheotomy is the term for the surgical incision or cut, while tracheostomy is the term for the opening that the incision creates.

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A tracheostomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a tracheostomy.

Other procedures that may be performed

An emergency medicine doctor or general surgeon may perform a cricoidotomy in an emergency. A cricoidotomy creates a hole in the trachea above the spot that may be later used for a tracheostomy. A cricoidotomy is a temporary treatment used to save your life until you are stable or a more permanent tracheostomy can be done. 

Why is a tracheostomy performed? 

Your doctor may recommend a tracheostomy when air is not getting to your lungs. Your doctor may only consider a tracheostomy for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion if time allows. 

Your doctor may recommend a tracheostomy for the following conditions: 

  • Blocked airway

  • Congenital (present at birth) airway defects

  • Injuries, such as airway burns from smoke, steam, gases or chemicals

  • Long-term coma

  • Long-term need for a mechanical ventilator because you cannot breathe on your own. This is the most common reason for a tracheostomy.

  • Need for removal of excess lung secretions or mucus due to a chronic lung disease 

  • Paralysis

  • Severe allergic reactions or infections

  • Spinal cord injuries

  • Surgery around or removal of the larynx (voice box). This may be necessary for diseases such as neck or throat cancer.

  • Surgery of the head, neck or trachea

  • Swallowing problems, which may be due to conditions such as a stroke

Who performs a tracheostomy?

The following specialists perform a tracheostomy:

  • Otolaryngologists (ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat. 

  • General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions. 

  • Critical care surgeons manage patients with life-threatening injuries or emergent surgical problems.

  • Emergency medicine and trauma doctors specialize in rapidly diagnosing and treating acute illnesses, conditions, injuries, and complications of chronic diseases.

  • Pediatric otolaryngologists (pediatric ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat in infants, children and adolescents.

  • Pediatric surgeons specialize in surgery for infants, children and adolescents.

How is a tracheostomy performed?

Your tracheostomy will be performed in a hospital. A tracheostomy is an open surgery. An open surgery incision allows your doctor to directly view and access the surgical area. Your surgeon will make cuts to expose your trachea (windpipe) and cut through the rings of cartilage that make up your trachea. Once your surgeon creates the stoma (hole), he or she will place a tracheostomy tube in the opening. 

Your surgical team will confirm the position and placement of the tracheostomy tube using a bronchoscope. A bronchoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a computer screen. Your doctor sees the surgical area on the video screen during the surgery. When the positioning is confirmed, your team will secure the tracheostomy tube in place using tape or ties or straps that go around your neck.

Your doctor will advise you on how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference.

Types of anesthesia that may be used

Your surgeon will perform your tracheostomy using general anesthesia, unless the situation is an emergency or critical in nature. Your care team will use local anesthesia in an emergency. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

  • Local anesthesia involves injecting an anesthetic medication around the area in your neck so you do not feel anything. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your tracheostomy

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The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or certified registered nurse anesthetist (CRNA) about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or CRNA will start your anesthesia.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a tracheostomy?  

As with all surgeries, a tracheostomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.  

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of a tracheostomy

Complications of a tracheostomy include:

  • Breakdown of the tissues that make up your trachea

  • Collapsed lung, punctured lung or pneumothorax. A pneumothorax is a condition in which air leaks into the space between your chest wall and the outer tissues of the lungs. This causes pain and shortness of breath.

  • Damage to your esophagus

  • Damage to your thyroid gland. Your thyroid gland is located on either side of your trachea (windpipe), just below your larynx (voice box).

  • Fistula development, an abnormal connection between your trachea and your esophagus

  • Nerve damage to the nerves that control your larynx

  • Severe scarring of your trachea that causes pain and difficulty breathing

  • Subcutaneous emphysema, a condition in which air becomes trapped beneath your skin

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

  • Informing your doctor or radiologist if you are nursing or if there is any possibility that you may be pregnant

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies 

How do I prepare for my tracheostomy?

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for a tracheostomy by:

  • Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. 

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a tracheostomy? Are there any other options for treating my condition?

  • How long will the surgery take? When can I go home?

  • Is my tracheostomy temporary or permanent?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • Will I be able to talk? How will I be able to communicate?

  • Who will teach my caregiver or me how to care for my tracheostomy site?

  • How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you? 

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my tracheostomy?

Knowing what to expect can help make your road to recovery after a tracheostomy as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may be moved to an intensive care unit (ICU) to recover. ICUs provide 24-hour specialized monitoring and care.  A hospital stay of one to three to ten days may then be required. 

Recovery after surgery is a gradual process. Recovery time varies depending on the reason for your tracheostomy, the type of tracheostomy (temporary or permanent), and if you need breathing support from a ventilator.  Other factors include the type of anesthesia used during the procedure, and your general health and age.

You may be unable to talk if your tracheostomy is connected to a ventilator. If not, it will still take some time for you to learn to communicate with a tracheostomy. Your doctor will likely recommend speech therapy to help you to talk again and test your ability to swallow food and liquids safely again. Once your tracheostomy is fully formed and healed, you may hear it referred to as “matured.”

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication. 

When should I call my doctor?

It is important to keep your follow-up appointments after a tracheostomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate, pas gas, or have a bowel movement

  • Irregular heartbeat or palpitations

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Pain that is not controlled by your pain medication

  • Thickened secretions or an inability to effectively clear your secretions out of your tracheostomy 

  • Unexpected drainage, pus, redness, tenderness or swelling of your incision

How might a tracheostomy affect my everyday life?

A tracheostomy may significantly reduce your symptoms so you can lead an active, normal life. For example, a tracheostomy may relieve or lessen your breathing problems. 

A tracheostomy can also cause changes that affect your everyday life, including the need to:

  • Avoid infections by practicing routine hand washing, getting any needed immunizations, and staying away from crowded places and sick people

  • Clean and care for your tracheostomy site, tubes and supplies

  • Have a caregiver who can perform cardiopulmonary resuscitation (CPR)

  • Have emergency supplies on hand as directed by your healthcare provider

  • Learn how to talk, swallow and eat with your tracheostomy

  • Use safety precautions when you are exposed to water, aerosols, sprays, powder, dust, particulates, or pet hair

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 4, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
  2. Tracheostomy Care. Cleveland Clinic. http://my.clevelandclinic.org/head_neck/patients/head_neck_cancer/tracheostomy_care.aspx
  3. Use Of A Tracheostomy With A Child.American Thoracic Society. http://patients.thoracic.org/information-series/en/resources/use-of-a-tracheostomy-with-a-child.pdf
  4. What is a Tracheostomy? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/trach/

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