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Tracheostomy—Adult

(Tracheotomy)

Definition

A tracheotomy is a surgery to make an opening in the neck. The opening is called a tracheotomy. It creates a path from the outside of the neck into the windpipe. A tube is often placed into the opening.

Reasons for Procedure

Illness or injury can make it hard to pass air through the upper airway. A tracheostomy makes a new path for air to pass through. It is most often done for people who need long term breathing support from a machine. It may be needed for a short time or permanent. A tracheotomy may be done because of:

  • The airway is blocked because of:
    • Trauma to the mouth or neck area
    • Tumors or infections in the upper airway
    • Vocal cord paralysis
    • Removal of part of throat as part of cancer treatment— laryngectomy
  • Respiratory failure that has caused a need for machine support to breathe, maybe caused by:
    • Spinal cord injury in the neck area
    • Severe lung infection or inflammation
  • The use of a machine to help with breathing for more than 2 to 3 weeks
  • Injury to the airway due to breathing in smoke or steam or harmful chemical
  • Birth defects of the throat or airways
  • Object blocking the throat or airways
  • Severe sleep apnea
  • Problems inhaling food or drink into lungs because of muscle or loss of feeling in the throat

Possible Complications

Your doctor will review a list of possible problems. Some problems may include:

  • Bleeding
  • Infection
  • Damage to the vocal cords, vocal cord nerves, or tube to stomach
  • Scarring at the site that can cause problems at the opening or tube to the lungs
  • Tube may fall out of place or be damaged
  • Hard time swallowing
  • Air gets trapped under the skin of the neck
  • Damage to the lungs
  • Low blood pressure
  • Abnormal connection to tube to stomach or nearby blood vessels

Some factors that may increase the risk of complications include:

  • Age: infants and older adults have higher risks
  • Obesity
  • Smoking
  • Poor nutrition
  • Recent illness, especially an upper-respiratory infection
  • Alcohol use disorder
  • Long-term illnesses
  • Use of certain medicine or recreational drugs

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Talk to your doctor about any medicine you are taking. You may need to stop taking some medicine up to one week before the procedure.

Anesthesia

General anesthesia will be used. You will be unaware of the procedure. In emergency situations, local anesthesia may be used. It will numb the area.

Description of Procedure

An incision will be made in the skin at the lower part of the front of your neck. The doctor will then be able to see the windpipe. A hole will be made in the windpipe. A tracheostomy tube will be placed into the hole. The tube will have wings that spread out along the skin. It will be stitched to the skin. A strap will be attached to the wings and placed around the neck to help keep the tube in place.

Immediately After Procedure

You will breathe through this tube as long as it is in place. Oxygen and machines to help with breathing will be used, if needed. A chest x-ray may be needed.

How Long Will It Take?

About 15 to 30 minutes

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You may have some pain and soreness during recovery. Your doctor can prescribe pain medicine to help.

Average Hospital Stay

The length of stay will depend on the reason for the procedure. Most stays are 1 to 5 days.

Post-procedure Care

Tracheostomy tubes need to be cared for on a regular basis. The care team will teach you how to clean and care for your tracheostomy tube. It will help prevent infection and allow air to flow freely.

A tracheostomy prevents you from speaking. There are tools and steps you can take to be able to speak again. A speech therapist will help you with this.

Nutrition will be given through an IV, a feeding tube through the throat, or a tube inserted into your stomach until you heal. A speech therapist can help you begin to swallow food again when you are ready.

The tube may be removed once you can move air through upper airway again. The opening may close on its own or need to be closed with a surgery.

Call Your Doctor

It is important for you to monitor your recovery. Alert your doctor to any problems right away. Call your doctor if you have any of these problems:

  • Signs of infection, including cough, bad-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 put it back in
  • You are having trouble breathing through your tube

If you think you have an emergency, call for medical help right away.

RESOURCES:

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

National Heart Lung and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Canadian Medical Association
http://www.cma.ca

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

REFERENCES:

Frequently asked questions about tracheotomy and swallowing. American Speech-Language-Hearing Association website. Available at: https://www.asha.org/practice-portal/professional-issues/tracheostomy-and-ventilator-dependence/. Accessed December 17, 2019.

Tracheostomy. National Heart Lung and Blood Institute. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/trach. Accessed December 17, 2019.

Tracheostomy in Adults. American Thoracic Society website. Available at: https://www.thoracic.org/patients/patient-resources/resources/tracheostomy-in-adults-1.pdf. Accessed December 17, 2019.

Tracheostomy Care (Respiratory Therapist). EBSCO Dynamic Health website. Available at:https://www.dynahealth.com/skills/t917677-tracheostomy-care-respiratory-therapist. Accessed December 17, 2019.

Last reviewed December 2019 by EBSCO Medical Review Board Nicole Meregian, PA  Last Updated: 12/17/2019