Tracheotomy is the surgical creation of an opening from the outside of the neck into the windpipe. Usually a tracheostomy tube is then inserted into the opening to allow for normal breathing.
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Reasons for Procedure
A tracheotomy is done to bypass obstructions in the upper airway that are interfering with breathing. The opening is called a stoma or tracheostomy. A stoma may be either temporary or permanent.
A tracheotomy is done to restore normal breathing in the following situations:
- The airway is obstructed at or above the level of the larynx, which is also known as the voice box, due to:
Respiratory failure requiring long-term mechanical breathing assistance, as in these cases:
- Spinal cord injury in the neck area
- Severe lung infection or inflammation
- The use of a ventilator for 21 days
- Injury to the respiratory tract due to breathing in smoke or steam or inhaling corrosive substances
- Birth defects of the trachea or larynx
- Foreign object blocking the trachea or larynx
- Severe sleep apnea
- Aspiration related to muscle or sensory problems in the throat
If you are planning to have a tracheotomy, your doctor will review a list of possible complications, which may include:
- Damage to the vocal cords, vocal cord nerves, or esophagus
- Scarring at the site of operation leading to closure of the tracheostomy or tracheal narrowing
- Tracheostomy tube displacement or damage
- Difficulty swallowing
- Air trapped in tissue under the skin of the neck
- Damage to the lungs
- Low blood pressure
- Abnormal connection to esophagus or surrounding blood vessels
Some factors that may increase the risk of complications include:
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Chest x-ray
- Blood and urine tests
- Review of medications
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
General anesthesia will be used. You will be asleep. In emergency situations, local anesthesia may be used. It will numb the area.
Description of Procedure
A cut will be made in the skin of the neck. A small incision will then be made in front of the windpipe between the cartilage. A tracheostomy tube, which will act as the airway, will then be fitted into this opening in the windpipe. The skin will be closed around the tube with stitches or clips.
Immediately After Procedure
You will breathe through this tube as long as it is in place. Oxygen and machines to assist breathing will be provided, if needed. A chest x-ray may be needed.
How Long Will It Take?
About 15-30 minutes
How Much Will It Hurt?
Anesthesia prevents pain during the procedure. You may have some pain and soreness during recovery. Your doctor can prescribe pain medication to help relieve this discomfort.
Average Hospital Stay
The length of stay will depend on the reason for the procedure. Most stays are 1-5 days.
Tracheostomy tubes need to be cared for on a regular basis. The hospital staff will teach you how to care for your tracheostomy tube. It is important follow the staff’s instructions to prevent infection and airway obstruction. Other specialists will help you adjust to the tracheotomy and learn how to speak and eat with the tracheostomy.
Tracheostomy tube care considerations include:
- Regular cleaning
- Regular clearing of secretions
- Keeping the airway open
- How to use oxygen or a humidifier (if needed)
- Learning to keep away from irritants that affect the airway
- Speaking and eating techniques
- Learning cardiopulmonary resuscitation (CPR)
- Knowing when to call for emergency medical services
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Signs of infection, including cough, excessive foul-smelling mucous, fever, and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Persistent nausea or vomiting
- Pain that you cannot control with the medications you were given
- Cough, shortness of breath, or chest pain
- Symptoms worsen
Call for emergency medical services right away if:
- Your tracheostomy tube falls out and you cannot replace it
- You are having difficulty breathing through your tube
If you think you have an emergency, call for medical help right away.
American Lung Association
National Heart Lung and Blood Institute
Canadian Medical Association
The Lung Association
Frequently asked questions about tracheotomy and swallowing. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/slp/clinical/frequently-asked-questions-on-tracheotomy-and-swallowing. Accessed August 29, 2017.
Tracheostomy. National Heart Lung and Blood Institute. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/trach. Updated December 9, 2016. Accessed August 29, 2017.
Tracheostomy in Adults. American Thoracic Society website. Available at: https://www.thoracic.org/patients/patient-resources/resources/tracheostomy-in-adults-1.pdf. Accessed August 29, 2017.
Tracheostomy tube replacement. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T909881/Tracheostomy-tube-replacement. Accessed August 29, 2017.
What is a tracheostomy? Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/tracheostomy/about/what.html. Accessed August 29, 2017.
Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 8/5/2015