A tracheostomy is one of the oldest medical procedures known today. It is also known as pharyngotomy and laryngotomy. The procedure involves making a surgical cut in the trachea on the outside of the neck to create a direct airway. This produces a stoma (opening) to work independently as an air passageway. It is also used to allow a tracheostomy breathing tube to be inserted. The opening and the tube lets an individual breathe without using their mouth or nose. Current medical procedures use either a needle-puncture or a surgical incision method.
A tracheostomy tube is a 2 to 3-inch plastic or metal device used to keep the trachea and stoma open to let air flow through to the lungs. It is also called a trach tube device.
What is the procedure of tracheostomy?
For most scheduled tracheostomies, you’ll be given general anesthesia
. This means you’ll fall asleep and won’t feel any pain. In emergencies, you’ll be injected with local anesthesia. This numbs the area of your neck where the hole is made. The procedure will begin only after the anesthesia has started working.
A cut will be made into your neck just below Adam’s apple by your surgeon.
The cut will go through the cartilage rings of the outer wall of your trachea, also known as your windpipe. Initially, a widened hole is stretched to fit tracheostomy
inside it. Your doctor may hook up the tube to a ventilator, in case you need a machine to breathe for you. The tube will be secured in place with a band that goes around your neck. This helps keep the tube in place while the skin around it heals. Your surgical team will tell you how to care for the wound and your tracheostomy tube.
How to prepare for tracheostomy?
After, a planned tracheostomy you will be instructed by the doctor for
the preparation of procedure. This may involve fasting for up to 12 hours before the procedure.
If your tracheostomy is performed during an emergency, there will be no time to prepare.
When is the procedure tracheostomy required?
The tracheostomy incision is typically performed for any one of these reasons:
- To get past a blocked upper air passageway that is stopping oxygen from reaching the lungs
- To take out and clean sections of the air passageway
- To safely and more easily bring oxygen into the lungs
After the procedure, the surgeons will check for a couple of days to see how the incision is healing. Often, the first trach device inserted during surgery will be replaced with a new one about 10 to 14 days after the surgery, depending on the patient's condition. Further replacements
are typically performed by the attending doctor or nurses on staff.
What is decannulation of tracheostomy?
A patient is considered a candidate for decannulation once the following conditions are met:
- Patient is alert and oriented and responsive to commands.
- Patient is no longer dependent on a ventilator for assisted breathing.
- The frequency requirement for tracheal suctioning is less than once a day. (This is not always the case. Check with your physician)
- Patient has met the criteria for decannulation outlined below.
Criteria for decannulation
- Patient should not be dependent on a ventilator.
- Patient’s mental state should be at a level of being alert, responsive and should be able to manage their oral secretions without a risk of aspiration.
- Should not require frequent suctioning for tracheal secretions.
- Patient should be able to cough and clean his/ her tracheal secretions.
- The patient should have their tracheostomy tube downsized to a size 4 Shiley or similar tracheostomy tube and they should not have breathing difficulty in the presence of this tube.
- The size 4 Shiley or similar tube should be occluded (with a trach plug/ cork) for twelve hours during the day with close monitoring by the nursing staff  with no evidence of respiratory difficulty or requiring of suctioning of the trach tube.
- Once the patient is seen to tolerate the steps in point # 6 above, their trach is plugged for twenty four hours and they are monitored for respiratory difficulty or suction requirement.
What to eat after tracheostomy?
may help with swallowing problems.
- Keep mealtimes relaxed.
- Sit up as straight as possible when you eat.
- Take small bites, less than 1 teaspoon (5 mL) of food per bite.
- Chew well and swallow your food before taking another bite.
In case a cough is experienced by you in the tracheostomy tube, then a speech therapist or provider will ensure the cough is deflated during meal times. This will make it easier to swallow.
What is the risk of tracheostomy?
Every medical procedure where the skin is broken carries the risk of infection and excessive bleeding. There’s also a chance of an allergic reaction to anesthesia, although it’s rare. Always ensure your doctor about your allergy of anesthesia if you have suffered with it in past. Risks specific to a tracheotomy include:
- Thyroid gland in neck can experience damage
- erosion of the trachea, which is rare
- lung puncture and lung collapse
- scar tissue in the trachea
Recovery after tracheostomy
The patient can have a hard time talking until they have a special, smaller tube inserted. The smaller tube can let air flow upwards out of the vocal cords. Whenever a patient needs a mechanical ventilator, the air is blocked from flowing past the tubular device by a balloon.
This makes the patient unable to produce any oral sounds. Eating by mouth may also be difficult until the smaller one is inserted. When a trach tubular device is needed for an extensive length of time, the family and the patient are instructed on how to care for it at home. This includes how to properly use home care medical equipment to suction the trachea, clean it and safely change the tube.
Some of the home healthcare supplies needed may include the following:
- Tracheostomy tube (one size smaller)
- Tracheostomy tubes
- Trach ties
- Hydrogen peroxide, sterile water, normal saline
- Blunt-end bandage scissors
- Gauze, dressing supplies
- KY Jelly or another water soluble lubricant
Tracheostomy cost for minimum Rs.65,000 to maximum Rs.1,30,000.