A tracheostomy is an incision in the trachea (windpipe). After the incision is made, a breathing tube is placed into it to enable the patient to breathe. It can be performed in an operating room by surgeons, and it may also be performed at a patient's bedside by an emergency medical technician or doctor. In emergencies such as choking incidents or car accidents, the procedure has been performed at the roadside and in restaurants using non-surgical tools. Some patients may have a temporary tracheostomy, and others will need to have a permanent tracheostomy.
The guide below discusses the reasons a tracheostomy may be performed and provides information about the associated preparation, surgical methods, risks, and recovery process.
Reasons The Procedure Is Performed
Doctors perform a tracheostomy so the patient has an air passage for breathing if their airway becomes blocked. It may also be done if the patient's airflow is significantly reduced. Patients with throat cancer, vocal cord paralysis, or other conditions that block or narrow the airway may need to have this procedure performed. It is most commonly carried out in situations where patients require breathing assistance with a ventilator for more than one to two weeks. A tracheostomy may be considered for patients with neurological conditions that prevent the patient from coughing up secretions, and it is generally recommended in instances where suctioning of the trachea is required to clear the patient's airway. Patients preparing for major surgery on the head or neck might have a tracheostomy performed so it is easier for them to breathe during their recovery. In an emergency, this procedure could be necessary if paramedics cannot insert a breathing tube into the patient's trachea through the mouth.
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Preparing For The Procedure
Patients having a tracheotomy performed in the hospital with general anesthesia will typically be asked not to eat anything after midnight on the night before their operation. Those having the procedure completed this way should ask their doctor for instructions about if drinking a few sips of water is permitted. The patient should ensure the surgeon is aware of their complete medication list. Anticoagulants and some other medications may need to be discontinued for a few days before the surgery, and the patient needs to ask their medical team for guidance on this. Since the patient will not be able to talk immediately after the surgery, doctors recommend bringing a smartphone, computer, or notebook to the hospital so the patient can communicate with others after the operation. Patients should also bring personal care items and all of their medications to the hospital with them, and it can be soothing to have a comfortable robe, pajamas, and slippers from home.
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How The Procedure Works
Surgeons typically choose from two methods when performing a tracheostomy. In a surgical tracheostomy, a horizontal incision is made on the lower portion of the front part of the neck. The surgeon carefully pulls back the underlying muscles and makes a small incision on a tiny part of the thyroid gland to expose the trachea. Once the surgeon locates a specific point on the trachea near the base of the neck, the tracheostomy hole is created. In a minimally invasive tracheostomy, sometimes known as a percutaneous tracheostomy, a tiny incision is made near the base of the front part of the neck. Then, the surgeon inserts a special lens down the patient's mouth so they can see the inside of the throat. Guided by the images from the lens, the surgeon places a needle into the patient's trachea to form the tracheostomy hole. The hole is widened to the appropriate size for the breathing tube. In both surgical methods, a tracheostomy tube is inserted into the tracheostomy hole. A neck strap is attached to the faceplate of the tube so it doesn't slip, and temporary sutures may be placed to keep the faceplate safely fastened to the skin of the patient's neck.
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Risks Linked To A Tracheostomy
While tracheostomies are generally very safe, there are some risks involved, particularly if the procedure must be performed in an emergency. Patients could experience bleeding, and the trachea, thyroid gland, or nerves in the neck may be damaged. The tube could be placed in the wrong location, or it might fall out during or after the procedure. If air becomes trapped in the tissue located underneath the skin of the patient's neck, a condition known as subcutaneous emphysema could develop. This might damage the esophagus or trachea, and patients may have difficulty breathing. Air may accumulate in the area between the lungs and the chest wall. This is called a pneumothorax, and it could lead to a collapsed lung. Long-term risks linked to a tracheostomy include narrowing and scarring of the trachea and the development of a tracheoesophageal fistula, an abnormal passageway that forms between the trachea and the esophagus. This type of fistula could allow fluids or food to enter the lungs. Some patients may get an infection in the trachea or bronchial tubes, and lung infections (pneumonia) have occurred.
Learn about the recovery process next.
Patients will typically need to spend a few days in the hospital after their procedure. As part of the recovery process, nurses will instruct the patient on how to clean the tracheostomy tube, and patients will also learn how to change the tube. These steps help reduce the risk of infection, and patients will need to continue cleaning and changing the tube for as long as they have a tracheostomy. Since eating will be too difficult at first, patients will be fed through a feeding tube, and they will work with a speech therapist to regain the necessary coordination for swallowing. Patients will be taught how to speak with their tracheostomy tube in place if possible, and they may need to use a heat and moisture exchanger to reduce the dryness of the air they inhale. Humidifiers may be recommended, and some individuals might need to learn how to use a suction device to clear secretions from the throat.