In certain situations, a person may be unable to breathe through their mouth or nose. If a doctor cannot get oxygen into the person's lungs with a face mask, they must create a surgical airway.
Sometimes, a person may require a surgical airway to assist their breathing, either for a fixed period or in the long term. In such cases, a doctor will insert a tube into the windpipe, or trachea. This procedure is called a tracheostomy.
Read on for more information on why a person might need a tracheostomy. We also describe the procedure and its possible complications.
Sometimes, a person may experience reduced airflow to the lungs, possibly due to an injury or blockage in the trachea. It may also occur as a result of a medical condition that affects lung function or blood oxygenation. Whatever the cause, a tracheostomy can assist a person with their breathing.
A tracheostomy involves cutting an opening into the trachea in the front of the neck. The doctor then inserts a tube into the opening, thereby creating a temporary or permanent surgical airway.
Some people will be able to breathe on their own through the tube. In other cases, a doctor may need to connect the tube to a ventilator or breathing machine.
Doctors will recommend a tracheostomy for a person who cannot breathe sufficiently on their own.
The procedure may sometimes be necessary for people with the following medical conditions, which can impair oxygen flow to the lungs:
- damage to the windpipe due to blockages, injuries, or radiation therapy
- severe pneumonia
- massive heart attack
- severe stroke
Doctors may first attempt to assist breathing by inserting a tube called an endotracheal tube into the windpipe via the mouth.
For long-term machine-assisted breathing, a tracheostomy is easier to manage and more comfortable than an endotracheal tube.
Doctors usually perform a tracheostomy in an emergency situation in which a person cannot breathe. To perform the procedure, the doctor will make a cut in the trachea in the front of the neck. They will then insert a tube into the opening and secure it in place with stitches or surgical tape.
The procedure takes about 20 to 45 minutes to complete.
Some people will be able to breathe on their own immediately after surgery, but others may require assistance from a breathing machine on an intensive care unit.
A person's trachea will heal in the week following the tracheostomy. The person may notice bleeding and scabbing around the opening in their neck.
After a week, the doctor will replace the tracheostomy tube with a new one. A person or their caregivers will receive instructions on how to remove, clean, and replace the tube at home. Regular cleaning helps prevent a buildup of mucus and debris, which can result in a blockage.
In some cases, a person who has received a tracheostomy may no longer require a tracheostomy tube. Physical therapy will be necessary to teach the person how to breathe on their own again without the tube.
Following the permanent removal of a tracheostomy tube, the surgical site will eventually close on its own.
After a tracheostomy, the skin surrounding the surgical opening will need cleaning several times a day. This cleaning helps prevent skin rashes due to excess moisture.
A person will also need to clean their tracheostomy tube every day. Some people may need to replace the tube every 1 to 3 months. A visiting nurse will give the person or their caregivers instructions on how to perform these tasks.
Caregivers will also need guidance on suctioning out debris and mucus from the tube. Suctioning can cause people to cough, and it may give them a sensation of breathlessness. Over time, people will get used to this feeling.
A person must tell their doctor if they notice any changes in mucus color as this could be a sign of infection.
People must take extra care when showering with a tracheostomy tube. Any water that enters the tube could end up in the lungs. Waterproof coverings for tracheostomy tubes are available.
People who have a tracheostomy tube may also require the following equipment and supplies:
- oxygen tanks
- portable suction machine
- disposable suction catheters
- saline solution
A tracheostomy can cause both short-term and long-term complications.
All surgical procedures carry some risks. Bleeding and infections are the most common complications.
In some cases, a tracheostomy tube may accidentally come out shortly after surgery. This complication can be dangerous as the person will be unable to breathe effectively on their own.
Short-term complications tend to occur in people who are frail, sick, or malnourished.
One potential long-term complication of a tracheostomy is damage to the windpipe, which can cause problems when a person removes the tracheostomy tube.
Sometimes, the tracheostomy tube can damage the area around the surgical opening. This injury can lead to infection and serious bleeding.
A tracheostomy tube can also increase the production of mucus in the airways. The excess mucus can block a person's lungs. Caregivers of people with tracheostomies need to undergo training on suctioning out mucus to prevent blockages.
The insertion of any tube into the airways can increase a person's risk of developing pneumonia.
There are several different types of procedure for managing airway obstructions and injury. We outline the differences between tracheostomy and the other procedures below.
Tracheostomy vs. tracheotomy
People often use the terms tracheostomy and tracheotomy interchangeably. However, a tracheotomy refers just to the procedure that creates a surgical opening in the trachea. A tracheostomy is the insertion of a tube to hold the airway open. If necessary, the tube can remain in place permanently. However, it is also possible to remove a tracheostomy.
An endotracheal tube is a PVC tube that a doctor may insert into the windpipe through the mouth or nose. The tube enables airflow to the lungs.
People may find endotracheal tubes uncomfortable. In some cases, the tubes may lead to the development of mouth ulcers and cause injuries to the vocal cords. This damage can make it difficult for a person to communicate with others.
A cricothyrotomy is a procedure that involves placing a tube through a cut in the cricothyroid membrane in the neck. Doctors may perform this procedure if they are unable to intubate a person who is not breathing.
Cricothyrotomy is a relatively high risk procedure. It is, therefore, the last step in surgical airway management.
A tracheostomy is a procedure that involves inserting a tube into a person's trachea to assist breathing. It is a form of long-term airway management for people with conditions that impair airflow to the lungs.
A tracheostomy tube can cause both short-term and long-term health complications. To minimize the risk of certain complications, a person with a tracheostomy and their caregivers must receive training in how to care for tracheostomy tubes. This care involves regular cleaning of the tube and the surgical site.