Tracheostomy

Definition:

A tracheostomy is an opening surgically created through the neck into the trachea (windpipe). A tube is usually placed through this opening (tracheostomy tube also trach tube) to provide an airway, and to allow removal of secretions from the lungs.

Description:

General anesthesia is used. The neck is cleaned and draped. Incisions are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then cuts two of these rings and inserts a tracheostomy tube.

Indications:

The guidelines for tracheostomy include:

Congenital (inherited) abnormality of the larynx or trachea
Severe neck or mouth injuries
Inhalation of corrosive material smoke or steam
Presence of a large foreign body that occludes the airway
Paralysis of the muscles that affect swallowing causing a danger of aspiration
Long term unconsciousness or coma

Risks:

Risks for any anesthesia are:

Reactions to medications
Problems breathing

Risks for any surgery are:

Bleeding
Infection

Additional risks include:

Erosion of the trachea (rare)
Scar tissue in the trachea

Expectations after surgery:

If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar. If the tracheostomy tube is permanent, the hole remains open and may require surgical closure when no longer needed.

Convalescence:

Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. Communication will require adjustment. Initially, it may be impossible for the patient to talk or make sounds.

After training and practice, most patients can learn to talk with a trach tube. Patients or parents learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available.

Normal lifestyles are encouraged and most activities can be resumed. When outside, a loose covering (a scarf or other protection) for the tracheostomy stoma (hole) is recommended. Patients must adhere to other safety precautions regarding exposure to water, aerosols, powder, or food particles as well.

Review Date: 10/31/2001
Reviewed By: Ashutosh Kacker, M.D., Department of Otolaryngology, New York Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network.

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