Reasons for a tracheostomy

Complications and Risks of Tracheostomy

As with any surgery, there are some risks associated with tracheotomies. However, serious infections are rare.

Early Complications that may arise during the tracheostomy procedure or soon thereafter include:

  • Bleeding
  • Air trapped around the lungs (pneumothorax)
  • Air trapped in the deeper layers of the chest(pneumomediastinum)
  • Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)
  • Damage to the swallowing tube (esophagus)
  • Injury to the nerve that moves the vocal cords (recurrent laryngeal nerve)
  • Tracheostomy tube can be blocked by blood clots, mucus or pressure of the airway walls. Blockages can be prevented by suctioning, humidifying the air, and selecting the appropriate tracheostomy tube.

Many of these early complications can be avoided or dealt with appropriately with our experienced surgeons in a hospital setting.

Over time, other complications may arise from the surgery.

Later Complications that may occur while the tracheostomy tube is in place include:

  • Accidental removal of the tracheostomy tube (accidental decannulation)
  • Infection in the trachea and around the tracheostomy tube
  • Windpipe itself may become damaged for a number of reasons, including pressure from the tube; bacteria that cause infections and form scar tissue; or friction from a tube that moves too much

These complications can usually be prevented or quickly dealt with if the caregiver has proper knowledge of how to care for the tracheostomy site.

Delayed Complications that may result after longer-term presence of a tracheostomy include:

  • Thinning (erosion) of the trachea from the tube rubbing against it (tracheomalacia)
  • Development of a small connection from the trachea (windpipe) to the esophagus (swallowing tube) which is called a tracheo-esophageal fistula
  • Development of bumps (granulation tissue) that may need to be surgically removed before decannulation (removal of trach tube) can occur
  • Narrowing or collapse of the airway above the site of the tracheostomy, possibly requiring an additional surgical procedure to repair it
  • Once the tracheostomy tube is removed, the opening may not close on its own. Tubes remaining in place for 16 weeks or longer are more at risk for needing surgical closure

A clean tracheostomy site, good tracheostomy tube care and regular examination of the airway by an otolaryngologist should minimize the occurrence of any of these complications.

High-risk groups

The risks associated with tracheostomies are higher in the following groups of patients:

  • children, especially newborns and infants
  • smokers
  • alcohol abusers
  • diabetics
  • immunocompromised patients
  • persons with chronic diseases or respiratory infections
  • persons taking steroids or cortisone

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A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients

During the study period, 455 patients underwent tracheostomy during their stay in the ICU. Twenty-eight patients were excluded because of previous history of tracheostomy (n = 15), neck surgery (n = 9), and cervical irradiation (n = 4). Of the 427 tracheostomies, 89 were performed in morbidly obese patients. Table 2 displays the characteristics of the study population. The two cohorts differed in age, BMI, and burden of comorbidity but were similar in gender and severity of illness on admission to the ICU. The most frequent underlying diagnoses for the need of critical care for the study population included pneumonia (21%), obstructive lung diseases (asthma and chronic obstructive pulmonary disease) (14%), postoperative non-vascular surgery (14%), and trauma and burn (13%). Only hypercapnic respiratory failure was reported more frequently in the morbidly obese group than in the control group (p < 0.001). Similarly, prolonged mechanical ventilation was more likely to be listed as the indication for tracheostomy in the morbidly obese group and failure to wean was more likely to be listed as the indication for tracheostomy in the control group. Nine tracheostomies were performed on an emergent basis, and two of these were in the morbidly obese group. The duration of mechanical ventilation prior to tracheostomy as well as the number of endotracheal intubations were comparable between the two groups.

Table 2 Characteristics of the study population

A total of 27 complications were recorded in 22 patients (25%) of the morbidly obese group compared to 65 complications in 49 patients (14%) of the control group (p = 0.03). Five morbidly obese patients had two complications, whereas 15 controls had two complications and one control had three. The severity and time period of complications for both study groups are detailed in Table 3.

Table 3 Early and late complications of tracheostomy

Minor bleeding was the most frequently reported complication in both groups (11% versus 7%; p = 0.24). Ninety-four percent of the cases (31 out of 33 cases) occurred during the first seven days postoperatively. In all of these instances, bleeding was controlled with light packing. Cuff leak represented the second most common complication in the study population (3% in the morbidly obese and 7% in the control group; p = 0.26), but unlike minor bleeding, these events were noted primarily after seven days of tracheostomy placement. Whereas cuff malfunctioning was responsible for early failure, loss of tracheal wall rigidity secondary to prolonged mechanical ventilation was responsible for the late complication in both cohorts.

Morbidly obese patients were particularly at higher risk for serious life-threatening complications. Overall, nine serious events were responsible for two deaths compared to seven cases and two deaths in the control group (p = 0.001 for serious events). Tube obstruction was the culprit in four of the nine morbidly obese cases. An early case was attributed to a blood clot after the patient had evidence of minor bleeding. The patient developed severe hypoxemia but the event was detected early while the patient was still in the ICU. In contrast, the other three cases occurred outside the critical care unit between 7 and 18 days after liberation from mechanical ventilation. Despite delivery of high humidity, two patients were found to have a mucous plug that led to severe hypoxemia and severe bradycardia. Anoxic encephalopathy ensued in both patients; in one case, the family requested termination of life support, whereas the other patient required transfer to a long-term care facility. Of interest, all three cases had non-fenestrated cuffed synthetic tubes in place. In the control group, one patient with reduced consciousness secondary to head trauma sustained a respiratory arrest after a mucous plug and did not survive resuscitation.

Accidental decannulation followed by extratracheal tube placement (false lumen) was the next most serious complication reported in the critically ill morbidly obese patients. Whereas none of the control group was identified with this complication, three morbidly obese patients had serious consequences from attempting to reinstate the tracheostomy tube. One complication occurred five days postoperatively after the patient removed the tube while on mechanical ventilation. The patient developed massive subcutaneous emphysema that resulted in bilateral tension pneumothorax and cardiorespiratory arrest. The other two complications developed 11 and 28 days after surgery when attempting to replace or downsize the tracheostomy tube. In both instances, orotracheal intubation was performed after both patients went into respiratory distress. A revision of the tracheostomy was performed subsequently without further complications.

The incidence of major bleeding was not significantly different between the two groups. One morbidly obese and four control patients had a decrease of hematocrit of more than 2 g/dl in the first 48 hours postoperatively, which was attributed to extensive oozing around the site of the wound. Bedside hemostasis was achieved by local packing and application of thrombin. Two control patients who had significant bleeding at 16 and 38 days after surgery were suspected of developing a tracheoinnominate artery fistula. One patient had a massive aspiration and could not be resuscitated. The other patient was transferred to the operating room, where an immediate exploration was performed and ligation of the bleeding vessel was conducted.

The rate and timing of stoma infection were also comparable between the two groups. Thirteen patients had local wound infection that was reported between days 2 and 10 of mechanical ventilation. Cultures of the wound showed predominance of gram-negative bacilli, notably Serratia marcescens (n = 1), Escherichia coli (n = 5), and Pseudomonas aeruginosa (n = 6). Apart from local antibiotic application, none of these patients required systemic antimicrobial therapy to treat the infection. Only one morbidly obese patient was found to have a paratracheal abscess after persistent fever that was unresponsive to systemic antimicrobial therapy. A computer tomography was diagnostic of the abscess, and the patient required prompt drainage followed by four weeks of therapy targeted toward gram-negative and anaerobic pathogens. None of our study population had tracheoesophageal fistula or injury to a nerve, artery, or vein during the postoperative period. Finally, no incidence of tracheal stenosis was observed during the length of hospitalization in either group.

Three factors (age, BMI, and Charlson index) found to be significant in univariate analysis were entered into multivariate analysis. Only BMI (odds ratio 4.4, 95% confidence interval 2.1 to 11.7) was independently associated with increased risk of tracheostomy-related complications.

Post decannulation

We have chosen to provide this information because recovery following tracheostomy frequently continues after patients leave hospital. This information should offer you practical help and advice on how to help recovery and who to contact if you have any concerns.

Why is this information important?

Patients who have tracheostomies frequently experience changes in their lifestyle (such as: swallowing; eating; drinking; talking; and coughing). Some of these changes may continue after the tracheostomy tube is removed – although frequently do get better.

Additionally, many patients who have had tracheostomy tubes will not yet have fully recovered from the illness or operation which caused them to need a tracheostomy tube. Therefore, knowing what to expect will help patients understand when they need to approach the hospital for a review of their condition.

What do patients need to be aware of?

Most importantly, if a patient develop noisy (often squeaky sounding) breathing at any time following tracheostomy tube removal they should call for help immediately (a nurse if they are in hospital or GP if they are at home). If the patient is feeling breathless, uncomfortable or panicky at the same time, they must dial 999 and ask for an ambulance.

What else do patients need to be aware of?

The following information is designed to help speed up recovery and let patients know when to contact the hospital:

  1. Healing of the tracheostomy wound: when the tracheostomy tube is removed the wound left should heal over within 1-2 weeks. Specific information will be given regarding this by the Hospital team but is it also important that:
    • The dressing covering it is changed if it becomes wet, or begins to leak or lift away from the skin;
    • The patient provides support for the wound by placing a finger on top of the dressing when talking or coughing;
    • Patients advise their nurse (in hospital) or GP (when home) if:
      • They are having to change dressings more often than before
      • If fluid on the dressing becomes more of a problem or changes colour (to green or red)
      • If the wound has not healed over or stopped leaking after two weeks following tracheostomy tube removal
      • If the scar which forms once the wound has healed is raised or very noticeable
  2. Pain or discomfort: Patients occasionally experience pain or discomfort in the area where the tracheostomy tube was, especially when speaking, swallowing or coughing. Occasionally some discomfort may be experienced when the head is moved (up or down or from left to right). Before a patient leaves hospital, they should receive advice on this matter (and this may include what medications should be taken to reduce any pain or discomfort). The following information may be of benefit:
    • Continue taking any pain killers which have been given until such a time as they are no longer needed (i.e. have little or no pain, or until a doctor, pharmacist or nurse advises not to take them);
    • Unless advised by a doctor, pharmacist or nurse, do not suddenly stop taking pain killers. Aim to reduce the amount taken over a few days before finally stopping
    • If new pains develop in the neck (particularly when swallowing), contact the hospital
    • Talking: Speech will be assessed prior to leaving hospital and patients may have received advice form the hospital’s Speech And Language Therapy Team (SALT). If the voice has altered this should be discussed with the hospital team before they go home. Additionally, be aware:
    • That changes in the voice are common during the first few weeks following tracheostomy tube removal. If this change is likely to be permanent, patients should be advised of this before they go home
    • If the voice changes (e.g. hoarseness, weakness, or whispering quality), patients should contact the hospital
  3. Eating and drinking: It is important that patients are capable of taking sufficient food and fluids when they return home. If this is likely to be a problem, they should discuss this with the nurse whilst in hospital. Patients may also be seen by the SALT team and/or a dietician for advice which should be followed for as long as they recommend. The hospital should be contacted if the patient experiences changes in their ability to eat or drink, specifically:
    • Difficulty swallowing
    • Vomiting shortly after eating/drinking
    • Coughing or difficulty breathing during or shortly after eating or drinking

Contacting St George’s University Hospitals NHS Foundation Trust

Patients should call for an ambulance (dial 999) if:

  • Their breathing becomes difficult or noisy whilst at rest

Patients should contact the hospital if they have:

  • Difficulty swallowing
  • Vomiting shortly after eating/drinking
  • Coughing or difficulty breathing during or shortly after eating or drinking
  • Noisy breathing during the day or night (this includes snoring in those patients who didn’t snore before they had a tracheostomy tube) – this may often be noticed by family or friends
  • A tracheostomy scar which is raised or uncomfortable one month or more after the tube has been removed
  • New pain or discomfort (particularly when swallowing)
  • A hoarse, weak, or whispering quality to your voice of more than one weeks duration

Reasons for a tracheostomy

A tracheostomy is usually done for one of three reasons:

  1. to bypass an obstructed upper airway;
  2. to clean and remove secretions from the airway;
  3. to more easily, and usually more safely, deliver oxygen to the lungs.

All tracheostomies are performed due to a lack of air getting to the lungs. There are many reasons why sufficient air cannot get to the lungs.

Airway Problems That May Require a Tracheostomy

  • Tumors, such as cystic hygroma
  • Laryngectomy
  • Infection, such as epiglottitis or croup
  • Subglottic Stenosis
  • Subglottic Web
  • Tracheomalacia
  • Vocal cord paralysis (VCP)
  • Laryngeal injury or spasms
  • Congenital abnormalities of the airway
  • Large tongue or small jaw that blocks airway
  • Treacher Collins and Pierre Robin Syndromes
  • Severe neck or mouth injuries
  • Airway burns from inhalation of corrosive material, smoke or steam
  • Obstructive sleep apnea
  • Foreign body obstruction

Lung Problems That May Require a Tracheostomy

  • Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)
  • Chronic pulmonary disease to reduce anatomic dead space
  • Chest wall injury
  • Diaphragm dysfunction

Other Reasons for a Tracheostomy

  • Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm
  • Aspiration related to muscle or sensory problems in the throat
  • Fracture of cervical vertebrae with spinal cord injury
  • Long-term unconsciousness or coma
  • Disorders of respiratory control such as congenital central hypoventilation or central apnea
  • Facial surgery and facial burns
  • Anaphylaxis (severe allergic reaction)

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What Is a Tracheostomy?

Tracheostomies help people breathe easier on a temporary basis, though some may be permanent.

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.

Tracheostomy Procedure

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
  • Infections
  • 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.

The respiratory system

There are two parts to the body’s breathing system ­ the upper airway and the lower airway. The nose, mouth, throat and larynx form the upper airway. The lower airway includes the windpipes (trachea), air tubes (bronchi), and air sacs (alveoli).

The nose is lined with a mucus membrane that has many blood vessels near the surface. The blood vessels pick up warmth and moisture as air passes through the nose. This is important because cold, dry air irritates the lungs. The nose is also lined with tiny hairs (called cilia). The cilia clean dirt and dust from the air before it passes into the throat and lungs.

The mouth does not warm and moisturize the air as well as the nose does. The mouth also does not have cilia to filter out the dirt and dust.

After the air goes through the nose or mouth, it enters the pharynx. The pharynx is the top part of the throat behind the nose and mouth. The other part of the throat ­ the larynx ­ is called the voice box and includes the vocal cords. As air passes through the larynx on the way out of the lungs, the vocal cords vibrate. The vibration is what makes the sounds when you talk.

The trachea is the tube-like structure that carries air from the throat to the lungs. The trachea divides into two tubes as it goes into the chest. The tubes are called the right and left main stem bronchi (BRONK eye).

Like branches on a tree, the two branches of the trachea divide into smaller tubes and end in the air sacs. The body gets rid of carbon dioxide and takes in oxygen through the air sacs (Picture 1).

Behind the trachea is the esophagus. The esophagus (eh SOF uh gus) is the tube that carries food from the mouth to the stomach. The trachea and the esophagus are two separate tubes.

Reasons for a tracheostomy

Your child’s doctor will talk with you about why your child needs a tracheostomy. The length of time your child has a trach tube depends on the reason for the trach tube. The tube helps breathing and helps clear mucus from the airway.

The more common reasons for a tracheostomy are listed below.

  • A blockage in the upper airway:if the upper airway is blocked, air cannot get into the lungs. The trach tube helps your child breathe.

    Paralyzed vocal cords may also block the upper airway. When the vocal cords do not open, air does not get through and the child cannot breathe. The trach tube lets the child breathe normally.

    Other conditions that may block the upper airway include polyps; narrowing of the trachea; or weak muscles in the trachea. When the muscles in the trachea are weak, the trachea closes and blocks airflow.

  • Inability to clear mucus from the lungs and airway: lungs make mucus. Mucus cleans the lungs by picking up tiny bits of dirt and dust. Cilia, which line the lungs, help the mucus carry the dirt and dust out of the lungs. This protects the lungs from irritation and infection.

    Some children are not able to cough mucus out of the lungs and airways. If mucus stays in the lungs, the child is more likely to get infections. The trach tube provides a way to help clear mucus from the lungs.

  • Long-term help with breathing:A trach tube is put in when a child has to be on a ventilator for a long time.Your child may have to use the ventilator at home after the trach is placed.There are many reasons why a child may need long-term help with breathing. You need to discuss this with your child’s doctor.

How a tracheostomy changes the respiratory system

When a tracheostomy tube is in place, the child breathes through the trach tube instead of through the nose or mouth. Therefore, very little air passes through the nose, mouth, or larynx. Remember, the nose and mouth warm and clean air during breathing. Air that passes through the larynx forms sound.

  • Your child will not be able to cry or talk while the trach tube is in place. Air passes out of the lungs through the trach tube. It does not go through the nose and mouth, and does not pass over the vocal cords to make them vibrate.
  • There are special devices that let a child talk with the trach tube in place.If your child can use one of these devices, the doctor or nurse will talk to you about it.
  • Air that enters the lungs through the trach tube is not warmed, humidified, or cleaned.This air can irritate the lungs. You will learn how to protect your child’s lungs from cool, dry, or dirty air.

The surgery

The surgery to insert a tube in the trachea is called a tracheostomy.

The surgeon makes an opening, called a stoma, in the front of the neck, below the larynx (Picture 2).

The surgeon puts a curved plastic tube called a tracheostomy tube into the stoma.

Choosing the trach tube

There are many types of trach tubes: uncuffed, cuffed, fenestrated, disposable, and reusable. The type of trach tube your child has depends on:

  • The reason your child needs the trach
  • The size of your child’s trachea

During the surgery, the doctor will put in the correct size and type of trach tube. Often the first trach tube has a cuff. The cuff is a filled balloon that seals off the air leak from the stoma. Right after the surgery, a trach with a cuff helps your child and the ventilator (breathing machine) work together to breathe.

The surgeon will change the first trach tube one week after surgery when the stoma has healed. If your child does not need a cuffed trach tube at that time, the surgeon will replace it then or before your child leaves the hospital.

Making the decision about a trach tube

It is not easy to decide about a tracheotomy for your child. You may have mixed feelings about it. Ask your doctor and trusted advisors any questions you may have.

A tracheostomy may be temporary or it may be permanent. The doctors will explain your child’s specific needs to you before the surgery. When your child has recovered from surgery, the doctors review his needs again and discuss this with you.

Sometimes a tracheostomy is permanent. Many children who have a tracheostomy might need to stay on a ventilator at home.

If you agree to a tracheostomy for your child, you will learn how to care for the trach, including:

  • Suctioning
  • Changing the trach tires
  • Doing CPR with a trach
  • Cleaning the stoma
  • Changing the trach tube
  • Problem-solving

You will go to classes in the Family Resource Center. There, you will practice these skills on a doll. Plan to go to class right after the trach surgery and before the first trach change by the surgeons.

You will help with your child’s trach care after he or she has the first trach tube change, and after you go to class. This allows you to practice at the hospital and learn what to do
at home.

When you are ready, you will do your child’s care for a 24-hour period at the hospital. Your child’s nurse will help when you need it. This is set up so you are prepared to care for your child at home.

Tracheostomy: What It Is and When It Is Needed (PDF)

HH II-198 5/12, Reviewed 11/17 Copyright 2012, Nationwide Children’s Hospital

Tracheostomy

A tracheostomy is a surgically made hole that goes through the front of your neck into your trachea, or windpipe. A breathing tube, called a trach tube, is placed through the hole and directly into your windpipe to help you breathe. A tracheostomy may be used to help people who need to be on ventilators for more than a couple of weeks or who have conditions that block the upper airways.

A surgeon can make a tracheostomy in a hospital operating room when you are asleep from general anesthesia. A doctor or emergency medical technician can make a tracheostomy safely at a patient’s bedside, such as in the intensive care unit (ICU), or elsewhere in a life-threatening situation. A tracheostomy usually takes 20 to 45 minutes to perform. The surgeon or other health care professional will make a cut through the lower front part of your neck and then cut into your windpipe. Cuffed trach tubes may be used. These tubes use air to widen or narrow the tube to fit the hole. After inserting and placing the trach tube into the windpipe, the surgeon or other health care professional will use stitches, surgical tape, or a Velcro band to hold the tube in place.

After getting the tracheostomy, you may stay in the hospital to recover depending on your health. It can take up to two weeks for a tracheostomy to fully form, or mature. During this time, you will not be able to eat normally and will likely receive nutrients through a feeding tube. You may have difficulty talking after your tracheostomy. A speech therapist can help you to regain normal swallowing ability and use your voice to speak clearly. Your trach tube will be removed when you no longer need it. The hole usually closes on its own, but surgery can close the hole if needed.

Tracheostomy is a fairly common and simple procedure, especially for critical care patients in hospitals. Soon after the procedure, it is possible to have bleeding, infection, pneumothorax or collapsed lung, or subcutaneous emphysema. Over time, complications may include windpipe scarring or an abnormal connection, called a fistula, between the windpipe and esophagus that causes food and saliva to enter your lungs. It is also possible to have complications that affect the function of the trach tube, such as the tube slipping or falling out of place, or that affect the windpipe or other airway structures. Proper care and handling of the tracheostomy, the tubes, and other related supplies can help reduce risks.

Visit Tracheostomy for more information about this topic.

Tracheostomy Care

What is a tracheostomy?

A tracheostomy is an opening (made by an incision) through the neck into the trachea (windpipe). A tracheostomy opens the airway and aids breathing.

A tracheostomy may be done in an emergency, at the patient’s bedside or in an operating room. Anesthesia (pain relief medication) may be used before the procedure. Depending on the person’s condition, the tracheostomy may be temporary or permanent.

When is a tracheostomy considered?

A tracheostomy may be performed for the following conditions:

  • Obstruction of the mouth or throat
  • Breathing difficulty caused by edema (swelling), injury or pulmonary (lung) conditions
  • Airway reconstruction following tracheal or laryngeal surgery
  • Airway protection from secretions or food because of swallowing problems
  • Airway protection after head and neck surgery
  • Long-term need for ventilator (breathing machine) support

What is a tracheostomy tube?

A tracheostomy (trach) tube is a small tube inserted into the tracheostomy to keep the stoma (opening) clear.

Tracheostomy tubes are available in several sizes and materials including semi-flexible plastic, rigid plastic or metal. The tubes are disposable or reusable. They may have an inner cannula that is either disposable or reusable. The tracheostomy tube may or may not have a cuff. Cuffed trach tubes are generally used for patients who have swallowing difficulties or who are receiving mechanical ventilation. Non-cuffed trach tubes are used to maintain the patient’s airway when a ventilator is not needed. The choice of tube is based on your condition, neck shape and size and purpose of the tracheostomy.

All trach tubes have an outer cannula (main shaft) and a neck-plate (flange). The flange rests on your neck over the stoma (opening). Holes on each side of the neck-plate allow you to insert trach tube ties to secure the trach tube in place.

What do I need to know after going home with a tracheostomy?

  • Immediately after the tracheostomy, you will communicate with others by writing until your healthcare provider gives you instruction for communication techniques.
  • Do not remove the outer cannula unless your healthcare provider has instructed you to do so.
  • Use tracheostomy covers to protect your airway from outside elements (such as dust, cold air, etc.) Ask your healthcare provider for more information about tracheostomy covers and where to purchase them.

When should I call my healthcare provider?

Contact your healthcare provider or physician immediately:

  • If you have an irregular heart rate.
  • If you feel increased pain or discomfort.
    Note: It is normal to feel some pain and discomfort for about a week after the tracheostomy procedure.
  • If you have difficulty breathing and it is not relieved by your usual method of clearing secretions.
  • When secretions become thick, if crusting occurs or mucus plugs are present. Your physician may recommend increasing your fluids or using cool mist humidification.
  • If you have any other problems or concerns.

How do I take care of my tracheostomy tube?

Your nurse will teach you the proper way to care for your tracheostomy tube before you go home. Routine tracheostomy care should be done at least once a day after you are discharged from the hospital.

  1. Gather the following supplies:
    • Two non-sterile gloves
    • A clean basin (or sink)
    • Hydrogen peroxide
    • Clean 4 x 4 fine mesh gauze pads
    • Normal saline or tap water (Use distilled water if you have a septic tank or well water)
    • Clean cotton-tipped swabs
    • Clean pipe cleaners or small brush
    • Clean washcloth
    • Clean towel
    • Trach tube ties
    • Clean scissors
  2. Wash your hands thoroughly with soap and water.
  3. Stand or sit in a comfortable position in front of a mirror (in the bathroom over the sink is a good place to care for your trach tube).
  4. Put on the gloves.
  5. Suction the trach tube. (Your healthcare provider will give you more information about the suctioning procedure).
  6. If your tube has an inner cannula, remove it. (If the trach tube does not have an inner cannula, go to step 12.)
  7. Hold the inner cannula over the basin and pour the hydrogen peroxide over and into it. Use as much hydrogen peroxide as you need to clean the inner cannula thoroughly.
  8. Clean the inner cannula with pipe cleaners or a small brush.
  9. Thoroughly rinse the inner cannula with normal saline, tap water or distilled water (if you have a septic tank or well water).
  10. Dry the inside and outside of the inner cannula completely with a clean 4 x 4 fine mesh gauze pad.
  11. Reinsert the inner cannula and lock it in place.
  12. Remove the soiled gauze dressing around your neck and throw it away.
  13. Inspect the skin around the stoma for redness, hardness, tenderness, drainage or a foul smell. If you notice any of these conditions, call your nurse or physician after you finish routine care.
  14. Soak the cotton-tipped swabs in a solution of half hydrogen peroxide and half water. Use the swabs to clean the exposed parts of the outer cannula and the skin around the stoma.
  15. Wet the wash cloth with normal saline, tap water or distilled water. Use the wash cloth to wipe away the hydrogen peroxide and clean the skin.
  16. Dry the exposed outer cannula and the skin around the stoma with a clean towel.
  17. Change the trach tube ties.

    • Measure and cut a piece of tie long enough to go around your neck twice. Cut the tie at an angle (Illustration 17c.) so it is easier to insert the tie into the neck-plate.
    • Untie one side of the old tie and remove that side from the neck-plate. Do not completely remove the old tie until the new one is in place and is securely fastened.
    • Holding the trach tube in place, lace the tie through one hole of the neck-plate, around the back of your neck, through the other hole of neck-plate, and again around the back of your neck.
    • Pull the tie snugly and tie a square knot on the side of your neck. There should be enough space for no more than two fingers between the tie and your neck. (Illustration 17d.)
    • Cut, remove and discard the old tie. If you have a cuffed trach tube, be careful not to cut the cuff balloon when removing the old trach tube tie.

  18. Place a fine mesh gauze under the tracheostomy tie and neck-plate by folding it or cutting a slit in it.
    Note: Some brands of mesh gauze are pre-cut.
    Important: Do not use 4 x 4 gauze or toppers – they contain cotton fibers which could clog your airway.

  19. Remove your gloves and throw them away.
  20. Wash your hands with soap and warm water.
  21. Wash the basin and small brush with soap and warm water. Dry them and put them away.
  22. Put the used washcloth and towel in the laundry.
  23. Wash your hands again with soap and warm water.

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Four-month-old Finley was struggling to breathe on her own. When doctors approached her parents about inserting a tracheostomy tube (often called a trach) through a hole in her windpipe, her mother, Alisa, was initially reluctant.

“I wanted this ‘normal’ baby. I wanted to come home from the hospital and have her learn to eat and walk and crawl,” Alisa recalls. “I just couldn’t see a way that would happen if Finley had this huge thing coming out of her neck. That’s all I saw in pictures online.”

Trachs are not as scary as they seem

Fortunately, Finley’s nurse showed Alisa and her husband pictures of trach tubes, which allow children to breathe when they can’t breathe normally through their nose and mouth. The nurse explained that Finley could leave the hospital if she had a trach — and that was the turning point for Alisa.

“When it became clear that Finley would need to start using the CPAP machine again or have the trach surgery and potentially go home, that was music to our ears,” Alisa says.

Now 14 months old, Finley is thriving, and Alisa loves caring for her at home.

“Finley has never been happier. She breathes easier, she doesn’t get ‘air-hungry’ anymore. She just doesn’t struggle,” Alisa says.

For Calyn and Trevor, whose 8-year-old daughter Laynie got a trach at 2 months old, the surgery was life-changing.

“As soon as Laynie got a trach, it was like my child came alive again. It’s amazing what your child can do when they can breathe easily and they’re not fighting for every breath,” Trevor expresses.

Your child doesn’t need to be limited by
their trach

Nine-year-old Presley has had a trach for more than 7 years, but her mom, Mindy, says their family continues to live a full life.

“When we first took a trip, it was to Park City, which is just 45 minutes from our house. Once we realized we could do that, we started going to California and lots of places around Utah. We’ve flown to Hawaii, we’ve gone on hot air balloon rides, and Presley plans on going to Mexico. We just live a really normal life,” Mindy says. “You have to give it more thought when you do go places, but it’s doable. You can still live the life you want to live and carry on as you were doing before the trach.”

Laynie has performed on a cheerleading team for 3 years and loves to be involved in family activities, including swimming.

“Her grandparents have a pool, and we all go swimming as a family probably 3 to 4 times a week during the summer. We just have to keep our hands on Laynie at all times, and we don’t let her go above her stomach in the water,” Calyn says. “She has a little mermaid tail she likes to splash around in.”

You have support all around you

Alisa recalls that her sister, who lives about 20 minutes away, attended the trach classes with Alisa and her husband.

“She came to all 5 of them, and she was learning right as we were learning. Then she came back and would practice on Finley and with us,” Alisa recalls. “I knew that out of everybody, she was going to be the closest family member, and that was a huge lifesaver.”

Alisa also connected with other moms at the hospital and through social media.

“There are a lot of Facebook communities for trach moms. Some of those moms who have older kids with trachs have all the tricks,” Alisa shares. “One of the NICU moms I met also became one of our best friends. She has a trach baby, and we text or call each other every single day. It’s been really nice to have a friend to lean on who’s going through the same thing we are.”

Mindy says her family, including her 6-year-old daughter, helps a lot with Presley’s trach care.

“Talk with your family and allow them to help. In the beginning, I really wanted full control. Allowing them to help and do things is actually going to save you a lot of stress, and it’s helpful for the child to know there are other people that can help them, too,” Mindy says. “If you let your kids be a part of trach care and explain things to them, it’s not scary.”

Your child can live a normal life

Trevor says Laynie’s doctors are amazed by how well she’s adjusted to the trach and other health problems.

“Laynie has the best attitude on the whole planet. Her trach has given her life, and she wouldn’t be here without it. Doctors can’t believe the progress she’s made,” Trevor says. “It’s pretty amazing what can accomplish.”

Mindy says Presley’s trach has become a natural part of life for their family.

“People always ask us how we do it, and I just let them know that this has become our new normal,” Mindy expresses. “You just have to have the mindset and the perception that your child can do anything. Decide what kind of life you want your child and your family to live, and figure out a way to make that happen.”

Learn more about tracheostomy tubes in the Intermountain Healthcare handout Let’s Talk About: Tracheostomy and watch the Caring for Your Child With a Tracheostomy video below!

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