{{YIELDBOT INTENT TAGS}} {{RUBICON REAL TIME}}
Tracheotomy
all information

Tracheotomy

(Tracheostomy)

En Español (Spanish Version)

Definition

Tracheotomy is the surgical creation of an opening into the windpipe to bypass obstructions that are interfering with breathing. A tube is inserted into the opening to allow for normal breathing. The opening is called a stoma or tracheostomy, and depending on the situation, may be either temporary or permanent.

When an airway must be created immediately, a slightly different procedure called a cricothyroidotomy may be done. The resulting airway should only be used temporarily, until the emergency situation is under control. If the airway will be necessary for more than 48 hours, a standard tracheotomy will be performed. This factsheet describes the standard tracheotomy.

Tracheostomy

Nucleus factsheet image

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Windpipe (trachea); muscles, blood vessels, and nerves in the neck

Reasons for Procedure

A tracheotomy is done to create an open airway to restore normal breathing in the following situations:

  • The airway is obstructed at or above the level of the larynx (voice box), due to:
    • Severe pneumonia
    • Insufficient clearing of fluid from the lungs
    • Trauma to the neck area with bleeding
    • Obstructing tumors of the upper airway
  • Respiratory failure requiring long-term mechanical breathing assistance, as in these cases:
    • Spinal cord injury in the neck area
    • Hospitalized patients requiring a breathing tube for more than 21 days
  • Sleep apnea (frequent stoppage of breathing during sleep)
  • Difficulty swallowing, resulting in excess saliva and mucus that can't be cleared (this can be due to paralysis of muscles necessary for swallowing, other neurological conditions, or a tumor)
  • Injury to the respiratory tract due to breathing in smoke or steam, or inhaling corrosive substances
  • Birth defects of the trachea or larynx
  • Foreign body blocking the trachea or larynx
  • Cancer of the throat or oral cavity leading to compression of the upper portion of the breathing tube

Risk Factors for Complications During the Procedure

  • Age: infants and adults over 75
  • Obesity
  • Smoking
  • Poor nutrition
  • Recent illness, especially an upper-respiratory infection
  • Alcoholism
  • Chronic illness
  • Diabetes
  • Use of certain prescription and nonprescription drugs

What to Expect

Prior to Procedure

Your doctor will likely do the following:

During Procedure

Anesthesia

Anesthesia

General (in emergency situations, local anesthesia may be given)

Description of the Procedure

An incision is made in the neck and the muscles and connective tissue around the windpipe are pulled apart. A section at the front of the windpipe is removed. A tracheostomy tube, which will act as the airway, is fitted into this opening in the windpipe. The skin is closed around the tube with stitches or clips, which can be removed about one week after surgery.

You will breathe through this tube as long as it is in place. Oxygen and mechanical assisted breathing can be provided, if necessary.

You will not be able to speak when the tube is in place unless you put a finger or other covering over the tube. This is because all air going in and out of the tube bypasses the vocal cords.

After Procedure

Chest x-rays, if necessary

How Long Will It Take?

15 to 30 minutes

Will It Hurt?

Anesthesia prevents pain during the procedure, although you may experience some pain and soreness during recovery. Your doctor can prescribe pain medications to help relieve this discomfort. Do not take pain medication for more than 4 to 7 days, and use only as much as you need. You may use nonprescription drugs for minor pain, such as acetaminophen, but do not use aspirin.

Possible Complications

  • Excessive bleeding
  • Pneumothorax (presence of air or gas in the space between the lungs and the tissue covering the lungs)
  • Low blood pressure
  • Tracheostomy tube displacement or damage
  • Irregular heartbeat
  • Infection
  • Damage to the vocal cords, vocal cord nerves, or esophagus
  • Scarring at the site of operation leading to closure of the tracheostomy
  • Scarring of the trachea that causes narrowing
  • Tube closure or displacement
  • Emphysema (destruction of lung tissue leading to insufficient lung function)
  • Mediastinal emphysema (bubbles of air in the tissues of the chest)
  • Difficulty swallowing

Average Hospital Stay

1 to 5 days, depending on the reason for the tracheotomy

Postoperative Care

  • Keep the stoma area clean; cleanse daily with mild soap and water or with hydrogen peroxide, and replace the dressing with a clean dry one.
  • Learn the proper daily care of your tracheostomy tube to maintain its long-term health and function; this includes the following, which you will be taught shortly after the surgery:
    • Cleaning the tube
    • Replacing the tube
    • Suctioning the tube regularly to keep it from becoming blocked with secretions
    • Humidifying the air you breathe
    • Covering the tracheostomy hole with a scarf or other cloth when going outside, so that dust, dirt, and other foreign particles don't get in
    • Being very cautious about breathing in water or small particles through the tracheostomy (such as food bits, powders, aerosol sprays, dust)
    • Covering the tracheostomy hole with your fingers in order to speak
  • Consult a speech therapist if recommended by your doctor.
  • Take antibiotics, if prescribed by your doctor.
  • Return to daily activities and work as soon as possible to promote healing.
  • Avoid vigorous exercise for six weeks after surgery.

Outcome

Allow about two weeks for recovery, and expect complete healing.

Once a tracheostomy tube is in place, you will experience breathing and vocal changes. It usually takes three days to adjust to breathing through the tube. Speaking is often a larger adjustment. Initially, you may not be able to speak and your doctor may recommend speech therapy.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough or shortness of breath that remains despite careful suctioning of the tracheostomy tube
  • Nausea or vomiting
  • Speech difficulties that persist after a temporary tracheostomy tube has been removed
  • New, unexplained symptoms develop
  • Call you local emergency number if your tracheostomy tube falls out and you can't replace it.

RESOURCES:

American Lung Association
http://www.lungusa.org

National Institutes of Health
http://www.nih.gov

CANADIAN RESOURCES:

Canadian Journal of Surgery
http://www.cma.ca

The Lung Association
http://www.lung.ca/

References:

Beers MH, Berkow R, et al. The Merck Manual of Diagnosis and Therapy . 18th ed. Merck & Co.; 2006.

Creighton University School of Medicine website. Available at: http://medicine.creighton.edu/ . Accessed October 14, 2005.

Medical encyclopedia: tracheostomy. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002955.htm . Accessed October 14, 2005.

The PDR Family Guide Encyclopedia of Medical Care . New York, NY: Ballantine Books; 1998.



Last reviewed October 2007 by Ronald Nath, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


Your Health and Happiness


DiggDeliciousNewsvineRedditStumbleTechnoratiFacebook