Tracheostomy

When you breathe, air comes in through your mouth or nose. It then flows down a tube in your throat called the trachea and into your lungs. But if you can’t breathe this way, a tracheostomy can be done to help you breathe.

A tracheostomy is also known as a trach (pronounced trake).

During a tracheostomy, a health care provider creates a small hole in the lower part of the front of the neck. A small tube is put into the hole. A manual airbag or breathing machine is connected to the tube. This allows air to go straight into your trachea and into the lungs instead of first going through the nose or mouth into the trachea and then into the lungs.

Your child may need a trach because their airway is blocked because of sudden injury, swelling that blocks the airway or infection. Tracheostomy is also done for problems swallowing or clearing mucus from the airways due to weak muscles, such as may occur after a stroke. These problems may be because of issues such as birth defects, burn injuries, severe allergic reactions, a need for chronic respiratory support with a mechanical ventilator, severe sleep apnea or traumatic injuries. Or these problems may be because of surgery to remove the voice box (larynx).

Most often, tracheostomy is done because a breathing machine (ventilator) is needed for a few weeks or longer. A ventilator blows air into the lungs through the tube put into the trach hole. Using a trach may prevent damage to the upper airway or vocal cords caused by putting an air tube through the mouth or nose for a long time.

If the tracheostomy is done in an emergency, the hole may be needed only for a short while. But in some cases, it may be needed permanently.

Like any surgery, a tracheostomy has some risks. These include:

• Bleeding or infection
• Nerve damage
• Damage to nearby blood vessels
• A buildup of air between a lung and your chest wall (pneumothorax) that can lead to a collapsed lung
• An abnormal connection (fistula) between the trachea and the tube that takes food and liquid from your mouth to your stomach (esophagus)
• Irritation of the lining of the windpipe
• Failure of the hole to close after the tracheostomy tube is no longer needed
• A scar on the neck
• Death

You may have other risks, depending upon your specific medical condition. Be sure to discuss any concerns with your health care provider before the tracheostomy procedure, if you can.

In some cases, a tracheostomy is done in an emergency. Sometimes a tracheostomy needs to be done at the scene of an accident.

In these cases, when possible, your child will be given local anesthesia on the neck to prevent pain. The neck area is cleaned. A cut is made in the lower front part of the neck. A thin tube is put in the hole. A manual airbag is then attached to an oxygen supply that is connected to the tube. When the bag is squeezed, air is pushed into the lungs as a way to artificially breathe.

For other kinds of tracheostomy, you will have time to prepare.

Ask your child's health care provider to tell you what you should do before your child's tracheostomy. Below is a list of common steps that your child may be asked to do.

• Weeks to days before the procedure, your provider will explain the procedure and ask if you have any questions
• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is unclear
• Your child's provider may do a physical exam to ensure your child is otherwise good health before you have the procedure. Your child may also have blood tests and other diagnostic tests
• Your child's provider may recommend taking an aspirin before the procedure
• Tell your child's provider if your child is sensitive to or allergic to any medicines, latex, iodine, tape, contrast dyes and anesthesia (local or general)
• Tell your child's provider of all prescribed and over-the-counter medicines, vitamins and herbal supplements that they are taking
• Tell your child's provider if your child have a history of bleeding disorders or if they are taking any blood-thinning medicines (anticoagulants), aspirin or other medicines that affect blood clotting. Your child may be told to stop certain medicines before the procedure
• Follow any directions your child is given for not eating or drinking before surgery

• Your child will be asked to remove any jewelry
• Your child will be asked to change into a hospital gown
• Your child will lie down on a surgical table
• Heart rate, blood pressure, breathing rate and oxygen level will be watched and recorded before and during the procedure
• Your child may be given extra oxygen as needed through a face mask or nasal tube
• To prevent pain or discomfort, your child will be given local anesthesia or general anesthesia
• The procedure should take about 20 to 45 minutes
• The skin on your child's neck is cleaned with an antiseptic solution
• The health care provider cuts through the skin in the lower part of the front of your neck
• The thyroid gland is pushed out of the way. In some cases, it may be separated in the middle to allow room for the tracheostomy tube
• The provider makes a cut in the trachea
• Next, the provider will place a tube into the hole to keep it open and allow air to pass through it
• The provider will use stitches to keep the tube (cannula) in place

Talk with your provider about what you can expect during your procedure

Your child's health care provider may give your child other instructions about what to do after their procedure. Here is a typical list.

• Your child's health care team may give them medicine to make them feel relaxed after the procedure
• Depending on why your child need the trach, they may need to stay in the hospital for a week or more
• Be aware that your child will not be able to talk after a trach unless a special tube is used. This is not a permanent condition (unless you need the trach permanently) and will resolve when the trach is removed
• If your child's trach is temporary, after the tube is removed, you’ll be given instructions for how to care for the wound. The hole should heal in a few days
• Your child will get medicine in the hospital to help control any pain or discomfort from the procedure or nausea following sedation
• If your child's trach is needed for a longer period, you’ll be given instructions for how to manage and care for it
• Your child may not be able to eat by mouth for the first week or two. Instead, your child may receive nutrition through an I.V. line in a vein or through a feeding tube put through your child's nose or mouth to the stomach
• Your child may need to learn how to swallow again before they can start to eat normally
• Your child may also need to use a device to keep their airway moist, particularly if they are receiving oxygen through a tube. One option is a device called an "artificial nose," or HME (heat and moisture exchanger). It goes over the end of the trach tube and holds in moisture
• Ask your child's health care provider about things you need to do each day to keep the tracheostomy clean and the airways clear. These include changing or cleaning the tube that goes down into the airway, cleaning the skin around the opening, and changing the ties that hold the trach tube in place
• Also ask your child's provider what to do if they're having trouble breathing because of a blockage in the tracheostomy tube or their airway. This can be life-threatening