Tracheostomy Emergency Algorithm (National Tracheostomy Safety Project)
What Is a Tracheostomy?
A tracheostomy is a surgical hole running through the front of the neck and into the trachea, or windpipe.
The procedure to create a tracheostomy is called a tracheotomy, though the two terms are sometimes used interchangeably.
During a tracheotomy, which is performed under general anesthesia, a horizontal incision will be made in the lower part of the neck.
Then the neck muscles will be pulled back and a cut will be made through the thyroid gland, exposing the trachea and allowing your surgeon to make an incision into it.
After the tracheostomy is created, a tube called a tracheostomy or "trach" will be inserted, which provides a breathing airway and allows secretions from the lungs to be removed.
There are numerous types of trach tubes available, which have different features that may be better suited for certain conditions.
Reasons for a Tracheostomy
Tracheostomies are usually temporary, but are sometimes long-term or even permanent.
Your doctor may recommend a tracheostomy if you’ll be using a ventilator to breathe for more than a couple of weeks.
Ventilators help people breathe easier by supplying air through a tube that can be piped into the trachea through the nose or mouth, or through a trach tube.
A tracheostomy may also be necessary if you have a condition, disease, or other issue that obstructs (blocks) your upper airways, such as:
- Large objects struck in the airways
- Neck cancer
- Diseases that paralyze or weaken muscles or nerves involved in breathing
- Spinal cord injuries
- Defects of the upper airways
You may need a tracheostomy if you have trouble coughing up mucus and bacteria struck in your airways.
In these cases, a trach tube can be used to suction mucus from your airways.
Tracheostomies are also useful for people who have trouble swallowing due to a stroke, surgery around the larynx, or another issue.
Risks and Complications
Some people experience complications immediately after the tracheostomy procedure, including nerve injury; bleeding and infection; and air trapped around the lungs (pneumothorax), in the deeper layers of the chest (pneumomediastinum), or beneath the skin around the tracheostomy (subcutaneous emphysema).
Other complications may develop over time, such as trachea scarring from infections, or a tracheo-esophageal fistula — an abnormal connection that forms between the trachea and esophagus.
Additionally, the trach tube may cause various complications, including:
- Abnormal tissue masses in the airways
- Collapse of the airways above the tracheostomy
- Erosion of the trachea from rubbing against the tube
- Dried secretions and mucus that block the tracheostomy
- Failure of the tracheostomy to close on its own after trach tube removal
Life after a Tracheostomy
People with a tracheostomy may be able to learn how to speak with the assistance of a special device.
After healing from the surgery, they may also need to learn how to eat again.
Speech therapists can help with both speaking and eating.
Video: Understanding Tracheostomy Tubes (National Tracheostomy Safety Project)
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