During the tracheotomy
A tracheotomy is most commonly performed in an operating room with general anesthesia, which makes you unaware of the surgical procedure. A local anesthetic to numb the neck and throat is used if the surgeon is worried about the airway being compromised from general anesthesia or if the procedure is being done in a hospital room rather than an operating room.
The type of procedure you undergo depends on why you need a tracheostomy and whether the procedure was planned. There are essentially two options:
- Surgical tracheotomy can be performed in an operating room or in a hospital room. During a surgical tracheotomy, the surgeon usually makes a horizontal incision through the skin at the lower part of the front of your neck. The surgeon carefully pulls back the surrounding muscles and cuts through a small portion of the thyroid gland, exposing the windpipe (trachea). At a specific spot on your windpipe near the base of your neck, the surgeon creates a hole and inserts a tracheostomy tube into the hole. A neck strap attached to the face plate of the tube keeps it from slipping out of the hole, and temporary sutures also can be used to secure the faceplate to the skin of your neck.
- Minimally invasive tracheotomy is typically performed in a hospital room. The doctor makes a small incision near the base of the front of the neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. Using this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole. The hole is then expanded to accommodate the tracheostomy tube. A neck strap attached to the faceplate of the tube keeps it from falling out of the windpipe.
What to expect with a tracheostomy
You'll likely spend several days in the hospital as your body heals. During that time, you'll learn skills necessary for maintaining and coping with your tracheostomy:
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- Caring for your tracheostomy tube. A nurse will teach you how to clean and change your tracheostomy tube. In general, you'll be asked to clean your tracheostomy site at least twice a day to help prevent infection. You'll continue to do this as long as you have a tracheostomy.
- Speaking. In general, a tracheostomy prevents you from speaking because exhaled air goes out the tracheostomy opening rather than up through your voice box. However, there are devices and techniques for redirecting airflow enough to produce speech. Depending on the tube size and design, the diameter of your trachea, and the condition of your voice box, you may be able to use your voice with the tube in place. If necessary, you'll meet with a speech therapist or a nurse trained in tracheostomy care, who can suggest options for communicating and help you learn to use your voice again.
- Eating. While you're healing, you'll receive nutrients through an intravenous (IV) line inserted into a vein in your body, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. When you're ready to eat again, you may need to work with a speech therapist, who can help you regain the muscle strength and coordination needed for swallowing.
- Coping with dry air. The air you breathe will be much drier since it no longer passes through your moist nose and throat before reaching your lungs. This can cause irritation, coughing and excess mucus coming out of the tracheostomy. Directly instilling small amounts of saline into the tracheostomy tube may help loosen secretions and add moisture. A saline nebulizer treatment can be delivered to a mist collar via a tube attached to a nebulizer machine. You may use a device called a heat and moisture exchanger, which captures moisture from the air you exhale and humidifies the air you inhale.
- Coping with other effects. Your health care team will show you ways to cope with the other common effects of the tracheostomy. For instance, you may also learn to use a suction machine to help you clear secretions from your throat or airway.
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- Flint PW, et al. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05283-2..X0001-8--TOP&isbn=978-0-323-05283-2&uniqId=230100505-57. Accessed May 17, 2013.
- Kasperbauer JL (expert opinion). Mayo Clinic, Rochester, Minn. June 10, 2013.