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A tracheostomy is a surgical procedure in which an opening is made through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway. This also allows for easier removal of secretions from the lungs.

Who is a candidate for the procedure?

• an abnormality of the larynx or trachea present at birth
• severe neck injuries or mouth injuries
• inhalation of damaging chemicals, smoke, or steam
• the presence of an object that blocks the airway
• paralysis of the muscles that affect swallowing, which can occur with strokes or neuromuscular disorders such as muscular dystrophy
• long-term unconsciousness or coma

How is the procedure performed?

If time permits, the person is taken to the operating room. The person will be given medication to make him or her sleepy. Many times, the procedure is done in the emergency department or even outside the hospital as an emergency life-saving maneuver, and there is no time to take the person to the operating room..

The neck is cleaned and sterile towels are applied. A surgical cut is made to expose the tough cartilage rings that make up the outer wall of the trachea. Small sections of two of these rings are cut and taken out, and a tube is inserted.

What happens right after the procedure?

• the tube will be tied in place using a special type of string
• the muscle and skin will be brought back together with stitches
• a sterile gauze dressing will be applied
• the person will not be able to talk while the tube is in place. It is important to have a paper and pencil for the person to write on after awakening.
• depending on the reason for the tracheostomy, the person may be attached to an artificial breathing machine, or ventilator
• frequent suctioning down the tracheostomy tube will be necessary to remove secretions

What happens later at home?

Occasionally the person will be discharged with the tube in place. They will need instruction on the care of their tracheostomy tube before leaving the hospital. Visiting nurses may be needed initially.

What are the potential complications after the procedure?

• mediastinal emphysema, or air under the tissue of the chest
• ejection of the tracheostomy tube when the person coughs. This complication can be prevented by properly securing the tube in place.