Tracheostomy

Definition
A tracheostomy is an opening surgically created through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway, and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

Description
General anesthesia is used. The neck is cleaned and draped. Surgical cuts 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
A tracheostomy may be performed because of:

     
  • An inherited abnormality of the larynx or trachea  
  • Severe neck or mouth injuries  
  • Breathing corrosive material smoke or steam  
  • A large object blocking the airway  
  • Paralysis of the muscles that affect swallowing  
  • Long-term unconsciousness or coma

Risks
The risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

The 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. It will take some time to learn how to communicate with others. 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.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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