Patient education: Tracheostomy (The Basics)

What is a tracheostomy? — A tracheostomy, or "trach," is a procedure where a doctor makes a cut in the neck to create an opening into the windpipe, or "trachea." The opening is called a stoma. A small tube (called a "tracheostomy tube" or "trach tube") is placed through the stoma into the trachea (figure 1).

A person might need a trach if they can't breathe regularly. For example, it can help people with certain diseases or injuries that affect the windpipe or vocal cords. A trach can be more comfortable for a person who is on a breathing machine, or "ventilator."

A trach can help keep the airway open and make it easier to remove secretions or "mucus" from the lungs. Some people only need a trach for a short time and others need it for a longer time, based on their condition.

Most of the time, people are already in the hospital when they are going to have a trach. The procedure can be done in a hospital room or in the operating room. To decide which is best, the doctor will consider:

●The person's age

●Why they need a trach

●If it is an emergency

What happens during tracheostomy? — When it is time for the procedure:

●The staff will place an "IV," which is a thin tube that goes into a vein. This can be used to give fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of the body so you don't feel pain. You might also get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a small cut in your neck and windpipe. They will put the trach tube through the opening and into your windpipe.

●The doctor will check that the tip of the tube is in the right place. If you have a breathing tube in place, it will be removed. If you are on a ventilator, it will be connected to the trach. You will breathe through the trach tube as long as it is in place.

●The doctor might stitch the tube in place while the opening has time to heal.

●The doctor will place gauze around the trach and use trach ties to keep the trach in place.

●The procedure usually takes 15 to 30 minutes.

What happens after tracheostomy? — After the procedure, you will be taken to a recovery room or back to the intensive care unit ("ICU"). The staff will watch you closely as the anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●You might have a little discomfort because of the tube. It can bother your throat and make you cough.

●The nurse might need to use a suction tube to clear the mucus from the trach tube. The trach might need suctioning if you:

•Have a moist cough that does not clear mucus

•Are unable to get rid of mucus from your throat

•Are having a hard time breathing, or feel like you cannot get enough air

What are the risks of tracheostomy? — The doctor will talk to you about all of the possible risks and answer any questions you have. Possible risks include:

●Bleeding

●The trach tube is in the wrong place

●Damage to your windpipe or lungs

●The trach tube becomes blocked with mucus or damaged

●The trach tube comes out

●Scarring

●Infection

What else should I know? — Before you go home from the hospital, make sure that you know how to care for the trach. You also need to know how, when, and why you might need to suction or change the trach tube.

Ask what problems to look out for and when you should call the doctor. Make sure that you understand the doctor's or nurse's instructions. Ask questions about anything that you do not understand.

More on this topic

Patient education: How to care for a tracheostomy (The Basics)
Patient education: Facial fractures (The Basics)
Patient education: Throat cancer (The Basics)
Patient education: Laryngeal cancer (The Basics)
Patient education: Acute respiratory distress syndrome (The Basics)