What is a tracheostomy?

A tracheostomy is a surgically created opening in the neck leading directly to the trachea (the breathing tube). It
is maintained open with a hollow tube called a tracheostomy tube.
Why is a tracheostomy performed?
A tracheostomy is usually done for one of three reasons: (1) to bypass an obstructed upper airway (an object
obstructing the upper airway will prevent oxygen from the mouth to reach the lungs); (2) to clean and remove
secretions from the airway; and (3) to more easily, and usually more safely, deliver oxygen to the lungs.
What are risks and complications of tracheostomy?
It is important to understand that a tracheostomy, as with all surgeries, involves potential complications and
possible injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and
healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or
potential complications. Tracheostomies are usually performed during emergency situations or on very ill
patients. This patient population is, therefore, at higher risk for a complication during and after the procedure
The following complications have been reported in the medical literature. This list is not meant to be inclusive
of every possible complication. It is listed here for information only in order to provide a greater awareness and
knowledge concerning the tracheostomy procedure.
• Airway obstruction and aspiration of secretions (rare).
• Bleeding. In very rare situations, the need for blood products or a blood transfusion.
• Damage to the larynx (voice box) or airway with resultant permanent change in voice (rare).
• Need for further and more aggressive surgery
• Infection
• Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required
• Scarring of the airway or erosion of the tube into the surrounding structures (rare).
• Need for a permanent tracheostomy. This is most likely the result of the disease process which made the
a tracheostomy necessary, and not from the actual procedure itself.
• Impaired swallowing and vocal function
• Scarring of the neck
Obviously, many of the types of patients who undergo a tracheostomy are seriously ill and have multiple organ-
system problems. The doctors will decide on the ideal timing for the tracheostomy based on the patient's status
and underlying medical conditions.
he tracheostomy procedure
In most situations, the surgery is performed in the intensive care unit or in the operating room. In either
location, the patient is continuously monitored by pulse oximeter (oxygen saturation) and cardiac rhythm
(EKG). The anesthesiologists usually use a mixture of an intravenous medication and a local anesthetic in order
to make the procedure comfortable for the patient.
The surgeon makes an incision low in the neck. The trachea is identified in the middle and an opening is created
to allow for the new breathing passage (tracheostomy tube) to be inserted below the voice box (larynx). Newer
techniques utilizing special instruments have made it possible to perform this procedure via a percutaneous
approach (a less invasive approach using a piercing method rather than an open surgical incision).
General instructions and follow-up care after tracheostomy
The surgeons will monitor the healing for several days after the tracheostomy. Usually, the initial tube that was
placed at the time of surgery will be changed to a new tube sometime between 10 and 14 days following
surgery, depending on the specific circumstances. Subsequent tube changes are usually managed by the treating
physician or nursing staff.
Speech will be difficult until the time comes for a special tube to be placed which may allow talking by
allowing the flow of air up to the vocal cords. Any time a patient requires mechanical ventilation, air is
prevented from leaking around the tube by a balloon. Therefore, while the patient is on a mechanical ventilator,
he/she will be unable to talk. Once the doctors are able to decrease the-size of the tube, speaking may be
possible. At the appropriate time, instructions will be given. Oral feeding may also be difficult until a smaller
tube is placed.
If the tracheostomy tube will be necessary for a long period of time, the patient and family will be instructed on
home care. This will include suctioning of the trachea, and changing and cleaning the tube. When the time
comes you will be provided with ample information, instruction, and practice. Often, home healthcare will be
provided, or the patient will be transferred to an intermediate health care facility.
In some cases (especially when performed during an emergency or prolonged intubation) the tracheostomy will
not be a permanent situation. If the patient can tolerate breathing without the tracheostomy tube the surgical site
can be closed, leaving a scar at the outside of the neck.
Tracheostomy At A Glance
• Tracheostomy is a surgical procedure to create an opening in the neck for direct access to
the trachea (the breathing tube).
• Tracheostomy is performed because of airway obstruction, problems with secretions, and
efficient oxygen delivery.
• Tracheostomy can have complications.
• A tracheostomy requires follow-up care
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Tracheostomy Care
WHAT YOU SHOULD KNOW
When a severe lung disorder, neurological problem, or infection makes it impossible to breath, your doctor
may do a tracheostomy (TRAY-kee-AH-stuh-mee) to keep your windpipe open and supply you with air.
During the procedure, the doctor makes a small opening called a stoma through the skin on your throat,
then inserts a breathing tube directly into the windpipe (trachea). This tube, called a "trach" (trayk) for
short, has three parts. One, called the obturator (AHB-ter-A-ter), is used to pass the trach into your
windpipe. When this part is removed, an outer cannula (tube) remains. This outer cannula has a plastic
"trach plate" that lies against the skin on your neck and holds the trach in place. Finally, there's an inner
cannula that fits inside the outer one and locks into place. The trach tube is sometimes sewn to the skin
around the stoma. It can also be held in place with trach ties. Some trach tubes have an inflatable cuff
near the outer end to keep them from coming out and to prevent air from leaking around them. As long as
the trach is in place, you'll need to clean the inner cannula on a daily basis. Whenever the tube threatens
to become clogged with mucus, you'll have to suction it clear. Both procedures are important. A dirty
cannula could lead to infection. And if the trach clogs up, you'll be unable to breath.

WHAT YOU SHOULD DO

• Cleaning the Trach: To prevent infection, clean the inner cannula at least once each day.
• You will need a small bowl, a small brush (like a toothbrush), liquid soap, a gauze pad, and
scissors.
• Position a mirror so that you can see your face and throat.
• Wash your hands with soap and water.
• Unlock the inner cannula and remove it by pulling it gently out and down.
• Put a clean wet inner cannula inside the outer cannula. Lock the inner cannula in place.
• Clean the dirty cannula by soaking it in liquid soap and water. Scrub it with the small brush. If it is
very dirty, soak it in 3 percent hydrogen peroxide. As the hydrogen peroxide works, it will bubble.
When the bubbling stops, clean the cannula with the brush.
• Rinse the inner cannula under running water. Make sure that all the soap and hydrogen peroxide
have been rinsed off well.
• Using a Trach Bib: A trach bib is used to catch any secretions that come from your stoma and
could make your skin sore. Open a 4-inch by 4-inch gauze pad. Unfold it completely, then fold it in
half (the long way). Turn down the corners to form a center opening about 1 to 2 inches long. The
gauze should now be shaped like a "U." Place the bib under the trach plate with the "U" upright.
• Making Sterile (germ-free) Water: Place a glass jar and its lid separately in a pan and cover
them with water. Boil for 5 minutes. Once they are sterilized, do not touch the inside of the jar or
lid. In another pan, boil normal tap water for 5 minutes. Pour the sterile water into the sterile jar.
Put the sterile lid on the jar.
• Suctioning the Trach Tube: When you can't cough up mucus that is blocking your windpipe, you
need to suction your trach tube.
• You will need a suction machine with suction tubing, a small bowl, sterile water, a suction catheter,
and sterile surgical gloves.
• Turn on the suction machine. Set the dial between -80 and -120 mm Hg. Attach suction tubing to
the suction machine.
• Fill the small bowl with some of the sterile water. Put the sterile lid back on the jar of sterile water
without touching the inside of either jar or lid. Set the small bowl to the side of your work table.
• Wash your hands with soap and water. Dry them, then put on sterile gloves.
• Take the suction catheter out of its package. Hook it to the suction tubing on the suction machine.
Dip the catheter tip into the sterile water. This will make the catheter easier to put into your trach.
To keep the catheter sterile, do not let it touch anything that is not already sterile.
• Take a few deep breaths. Gently thread the wet catheter into the trach tube. Advance the catheter
5 to 8 inches, until you feel it pushing against something. Do not cover the catheter's control valve
while inserting the catheter. The control valve is the small hole near the end that is in your hand.
Covering it starts the suction.
• Slowly pull the catheter out of your trachea, rolling it back and forth between your thumb and
fingers. As you pull it out, use your thumb to cover and uncover the control valve. This will start
and stop the suction. Do not keep the valve covered for more than 10 seconds at a time. If you
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