Having a Tracheostomy

This section is designed to give you information about having a tracheostomy and the care you will receive before, during and after your operation.

A tracheotomy is an opening into the trachea (windpipe) and inserting a tracheostomy tube helps to keep it open. The tube is held in place by soft Velcro straps or ties that are tied around the neck. The opening or hole in your neck, into which the tracheostomy tube is inserted is referred to as a stoma.

It is important that you keep the tracheostomy tube in place except for a very short time when it is being changed. Without a tracheostomy tube in place the opening or stoma will close naturally.

A tracheostomy is performed to make breathing easier and may be required for many different reasons:

1. Obstruction of the upper airways

Breathing becomes difficult or noisy because air cannot pass from the nose and mouth through the voice box and trachea (windpipe) to the lungs.

2. Respiratory failure / Respiratory Support

This is where the lungs are not working properly and a tracheostomy can reduce the effort needed for breathing. Sometimes it is necessary to have the help of a machine in order for the lungs to work more effectively. This is called a ventilator.

3. Excessive chest secretions

A tracheostomy provides an opening into the windpipe and makes it easier to remove chest mucus using special suction equipment. This makes breathing much easier.

4. Major surgery of the head and neck areas.

Planned surgical operations on the head and neck areas may cause swelling to tissues internally and may cause obstruction of the flow of air. This makes breathing through the nose and mouth very difficult. Therefore for a short period after surgery a tracheostomy will be required until the healing takes place and swelling resolves. Your consultant will discuss this with you.

5. To protect the chest when swallowing reflexes are missing.

This is when the swallowing mechanisms are not working properly and there is a chance of food contents and drinks being inhaled into the windpipe and lungs.

A tracheostomy can be removed and the opening will naturally close once the tracheostomy tube is not present. However the problem which required you to have the tracheostomy will need to be resolved. Your consultant will discuss this with you.

There are two ways of inserting a tracheostomy.

1. Surgical tracheostomy

A surgical tracheosotomy is almost always undertaken in an operating theatre. The operation can be undertaken under a local anaesthetic (when you remain awake and the neck area is numbed) or a general anaesthetic (where you are fully unconscious). Your consultant will discuss this with you. The operation takes about 45 minutes.

To prevent vomiting and other complications during the operations it is necessary for you to starve (have nothing by mouth or no chewing gum) for at least 6 hours before the operation. You will be advised of what time to starve from when you attend the pre-admission assessment.

2. Percutaneous Tracheostomy

This is usually performed in the Intensive Care Unit