A tracheostomy, often called a “trach,” is a surgically created opening in the front of the neck leading directly into the windpipe (trachea). This opening establishes an alternative pathway for air to reach the lungs, bypassing the nose and mouth. The procedure, known as a tracheotomy, is performed when a person has an upper airway obstruction, requires long-term mechanical breathing assistance, or needs help clearing lung secretions.
The Physical Appearance of the Stoma
The opening itself, called a stoma, is a small hole located in the lower neck area. In a mature tracheostomy, the stoma has healed around the tube, appearing as a coin-sized opening in the skin. The tube is held in place by a neck flange—a flat plate resting flush against the skin—and secured with specialized ties or straps around the neck.
Immediately after the procedure, the incision site may show some redness and temporary sutures. Over time, the skin around the stoma heals, creating a smooth, circular opening. The flange, which is usually plastic, prevents the tube from slipping further and is the most apparent physical sign of the device.
Understanding the Tracheostomy Tube Components
The tracheostomy tube is a complex device composed of three main parts that work together to maintain the airway.
Tube Components
The three primary components are:
- The outer cannula is the main body of the tube, a curved shaft that remains permanently in the trachea to keep the stoma open. The neck flange is attached to the outer end and contains information about the tube’s size.
- The inner cannula is a smaller, removable tube that fits inside the outer cannula and can be taken out for cleaning. This liner prevents the main tube from becoming blocked by mucus.
- The obturator is a rigid, curved guide used only during the initial insertion of the outer cannula. It provides a smooth, rounded tip to minimize trauma and is immediately removed once the tube is in place to allow for airflow.
Cuffed vs. Uncuffed Tubes
Tubes come in two primary types: cuffed and uncuffed. A cuffed tube has a small, inflatable balloon near its tip that creates a seal against the tracheal wall when inflated. This cuff is connected to an external pilot balloon, a small, visible projection indicating the cuff’s status. Cuffed tubes are used for people on mechanical ventilation or to prevent material from the throat from entering the lower airway. Uncuffed tubes lack this balloon feature and are used for individuals who can breathe spontaneously.
How a Tracheostomy Changes Basic Functions
Breathing through a tracheostomy involves a significant functional change because air is no longer filtered, warmed, or humidified by the nose and mouth. Air travels directly through the tube into the trachea, which can lead to drier airways and a buildup of thicker secretions. Coughing and clearing the airway can also be less effective due to the tube’s presence and altered airflow dynamics.
Speech
The ability to speak is often affected because air bypasses the vocal cords. With an open tracheostomy tube, air is exhaled directly out the neck, preventing it from flowing up past the voice box to create sound. Speech can be restored using a one-way speaking valve, which allows air inhalation through the tube but forces exhaled air up through the vocal cords.
Swallowing
Swallowing can become more difficult (dysphagia) due to the tube’s presence. The tube restricts the normal upward movement of the larynx necessary for the epiglottis to close the airway. An inflated cuff can also press on the esophagus, complicating the passage of food and liquid. Deflating the cuff or using a cuffless tube helps restore a more normal swallowing mechanism.