A tracheostomy is a medical procedure that creates an alternate pathway for breathing. It involves a surgeon making an opening through the skin of the neck and into the windpipe, which is the trachea. This resulting opening is called a stoma, and a specialized device known as a tracheostomy tube is immediately inserted. The purpose of this tube is to keep the stoma open, allowing air to bypass the upper airway and deliver oxygen directly to the lungs.
Placement and Appearance of the Stoma
The stoma, which is the visible opening, is located on the front of the neck, typically in the lower part, well below the Adam’s apple or voice box. Surgeons usually create this small, round opening between the second and third cartilaginous rings of the trachea. The actual hole in the skin is only as large as the diameter of the tube being used, which for adults is commonly around 10 to 12 millimeters in outer diameter.
When the tube is in place, only the neck plate, or flange, and the end of the tube are visible resting against the skin. The skin immediately surrounding the stoma may appear slightly red, particularly during the initial healing period, due to the presence of the foreign object. Routine care is essential to keep the area clean and dry, which helps prevent irritation and the buildup of secretions. If the tube were briefly removed, the stoma would look like a small, moist, circular hole in the skin and the front wall of the trachea.
Essential Components of the Tracheostomy Tube
The visible portion of the tracheostomy is primarily the tube assembly, which consists of several distinct parts. The main structure inserted into the airway is the outer cannula, which stays in place until the entire tube is changed. An inner cannula often fits inside the outer one and can be removed quickly for cleaning, which helps prevent mucus from blocking the airway.
The flange is the flat, wing-like piece of plastic or metal that rests flush against the neck, held in place by specialized ties wrapped around the neck. This neck plate is where important information like the tube size and type are imprinted. Tubes are manufactured in different materials, such as rigid plastic (PVC), soft silicone, or stainless steel, which affects their color and texture.
A major difference is between cuffed and uncuffed tubes. A cuffed tube has a small, inflatable balloon near the end that is inside the trachea to create a seal, preventing air leakage or material from entering the lungs. The cuff is managed by a thin inflation line running outside the tube to a small pilot balloon, which shows whether the cuff is inflated or deflated. The obturator is a smooth guide used only during insertion to protect the tissue and is immediately removed once the tube is seated correctly.
External Attachments and Visual Variations
The setup’s appearance changes significantly depending on the patient’s breathing needs and activity. The end of the tracheostomy tube that sticks out from the neck, known as the hub, is a universal 15-millimeter connector on many models. This standardized port allows for the quick attachment of various accessories or connection to respiratory equipment.
If the person needs mechanical support, the tube will be connected to the flexible, corrugated tubing of a ventilator circuit, which can look bulky. For individuals who are not ventilator-dependent, a small, often colored, plastic cap called a speaking valve may be attached to the hub. This valve is a one-way mechanism that allows air to enter through the tube but forces the exhaled air up through the vocal cords, enabling speech.
Other common external variations include a Heat and Moisture Exchanger (HME), which is a small, filter-like device that sits on the tube opening to warm and humidify the air. When a person is ready for the tube to be potentially removed, a solid cap or plug may be placed over the hub to block the opening completely. This forces the patient to breathe entirely through their natural airway, which is a final test before the stoma is allowed to heal closed.