Tracheostomy

What is a tracheostomy?

A tracheostomy, also known as a tracheotomy or a stoma, is a small surgical opening that is made through the front of the neck into your windpipe, or trachea.

A curved plastic tube, known as a tracheostomy tube, is placed through the hole to allow air to flow in and out of your windpipe. The tube does not go down into into your lungs.

The tube allows you to breathe through your throat, bypassing your upper airway, including your nose and mouth. A tracheostomy may be temporary or permanent. It may be done during an emergency or as a planned procedure.

Why is a tracheostomy performed?

A tracheostomy is performed when an adult or child has a condition that makes normal breathing difficult or impossible.

The 3 main reasons you might need a tracheostomy are:

• to allow you to breathe when you have an upper airway blockage, such as may occur with:
  • tumours
  • upper airway swelling or narrowing for another reason
• to allow you to get help to breathe using a machine (ventilator), such as with:
  • spinal injuries
  • conditions that lead to weak respiratory (breathing) muscles
• to allow access to your airway, so saliva and mucus can be removed by suction

What does a tracheostomy involve?

A tracheostomy invovles surgery that is usually done under a combination of local and a light general anaesthetic.

A small incision (cut) is made in the throat and a tracheostomy tube is inserted into the windpipe. The tube sits in the windpipe and stays in place using tape or velcro. There may also be a few stitches to help keep it in place.

After the procedure, most people spend some time in the intensive care unit (ICU), before moving to a hospital ward. This is to make sure that the wound is healing well and that the tube can be changed safely.

Many people can start eating and drinking by mouth again once they have recovered from the operation. This may be 1 to 2 weeks after the procedure. Depending on the reason for the tracheostomy, some people may need to be fed via a feeding tube.

What happens after a tracheostomy?

Doctors, nurses, physiotherapists, dietitians and speech therapists work together to help care for people who have a tracheostomy.

After surgery, nurses may need to suction mucus out of the tube. Physiotherapists can help keep the lungs clear of mucus, and speech therapists can help with swallowing and speaking.

The tracheostomy tube needs to be changed regularly. When you go home with a tracheostomy, your health team will give you instructions on how to care for it, as well as what to do in an emergency. You may need to come back to hospital to have the tube changed or you your health team may teach you how to change your own or your child’s tube at home.

What are the risks and side effects of tracheostomy?

The risks of tracheostomy can include:

• bleeding and damage to the throat
• blockage of the tube with secretions (such as mucus or saliva), which may be aspirated (breathed) into the lungs and cause pneumonia (aspiration pneumonia)
• infection
• tube displacement
• scar formation

Less common risks include:

• narrowing of the windpipe
• a fistula (hole forming between the windpipe and the food pipe)
• a granuloma (a small area of inflamed tissue) forming

What are the alternatives to a tracheostomy?

Tracheostomies are usually performed as a last resort. If there are other options suitable, your doctor will likely recommend them first. In an emergency situation, a tracheostomy could save your life.