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Tracheotomy—Adult

(Tracheostomy)

Definition

Tracheotomy is the surgical creation of an opening from the outside of the neck into the windpipe. A tube is inserted into the opening to allow for normal breathing.
Tracheostomy
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Reasons for Procedure

A tracheotomy is done to bypass obstructions 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:
    • Trauma to the neck area
    • Obstructing tumors in the upper airway
    • Vocal cord paralysis
    • Removal of larynx for throat cancer
  • Respiratory failure requiring long-term mechanical breathing assistance, as in these cases:
    • Spinal cord injury in the neck area
    • Severe lung infection or inflammation
  • If you have been on 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

Possible Complications

If you are planning to have a tracheotomy, your doctor will review a list of possible complications, which may include:
  • Bleeding
  • Infection
  • Damage to the vocal cords, vocal cord nerves, or esophagus
  • Damage to the lungs
  • Difficulty swallowing
  • Air trapped in tissue under the skin of the neck
  • Low blood pressure
  • Tracheostomy tube displacement or damage
  • Scarring at the site of operation leading to closure of the tracheostomy or tracheal narrowing
  • Abnormal connection to esophagus or surrounding blood vessels
Some factors that may increase the risk of complications include:
  • Age: infants and elderly adults
  • Obesity
  • Smoking
  • Poor nutrition
  • Recent illness, especially an upper-respiratory infection
  • Alcoholism
  • Long-term illnesses
  • Use of certain prescription and nonprescription drugs

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.

Anesthesia

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 section at the front of the windpipe will be removed. 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.

Post-procedure Care

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 have been given
  • Cough, shortness of breath, or chest pain
  • New, unexplained symptoms
Call for emergency medical services right away if:
  • Your tracheostomy tube falls out and you can't replace it
  • You are having difficulty 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

Caring for your tracheotomy. University of Miami Health System website. Available at: http://calder.med.miami.edu/pointis/traccare.html. Accessed September 17, 2013.

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 September 17, 2013.

Tracheostomy (putting a breathing tube through a small hole in the throat). American Thoracic Society website. Available at: http://www.thoracic.org/clinical/critical-care/patient-information/icu-devices-and-procedures/tracheostomy-putting-a-breathing-tube-through-a-small-hole-in-the-throat.php. Accessed September 17, 2013.

What is a tracheostomy? Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/tracheostomy/about/what.html. Accessed September 17, 2013.

Revision Information

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