A tracheostomy, often referred to as a “breathing trach,” is a surgically created opening in the front of the neck that leads directly into the trachea, or windpipe. This procedure establishes an alternative airway, allowing air to bypass the nose, mouth, and throat to reach the lungs. It serves as a means to help a person breathe when their natural airway is compromised.
Understanding a Tracheostomy
The procedure creates a stoma, an opening in the trachea. During the procedure, a surgeon makes an incision in the lower front neck, exposing the windpipe. A small hole is then made in the trachea, and a tracheostomy tube is inserted through this opening. This tube is secured in place, often with a neck strap or sutures, to maintain the open airway.
The tracheostomy tube itself usually consists of an outer cannula, which remains in place, and an inner cannula that can be removed for cleaning. An obturator, a guide, is used during insertion of the outer cannula and is removed once the tube is in its proper position. This design allows for air to flow directly into the lungs, bypassing any upper airway obstructions, and also facilitates the removal of secretions.
Reasons for a Tracheostomy
A tracheostomy may be needed when the natural airway is blocked or breathing is severely impaired. One common reason is the need for prolonged mechanical ventilation, where a breathing machine supports respiration. A tracheostomy can offer a more comfortable and safer alternative to a tube placed through the mouth or nose for long-term ventilation.
Upper airway obstruction is another indication, caused by injuries, tumors, severe swelling, or congenital abnormalities. Vocal cord paralysis or narrowing of the voice box or trachea can also block airflow. Additionally, individuals who have difficulty clearing secretions from their lungs due to conditions like neuromuscular disorders or chronic lung diseases may require a tracheostomy to allow for effective suctioning.
Daily Life with a Tracheostomy
Adjusting to daily life with a tracheostomy involves adapting to changes in communication, eating, and personal care routines.
Communication can be challenging because air may no longer pass over the vocal cords. Many individuals with tracheostomies can learn to speak again, often with speaking valves that redirect air over the vocal cords. If verbal communication is not possible, alternative methods like writing, communication boards, or gestures can be effective.
Eating and swallowing may also present challenges, as the tracheostomy tube can affect breathing and swallowing coordination. Patients are advised to eat slowly, chew food thoroughly, and sit upright; some may need to deflate a cuffed tube before meals. Adequate fluid intake is also encouraged to help thin secretions and make them easier to manage. For hygiene, prevent water from entering the tracheostomy tube during bathing or showering, often by using a shower shield. Individuals with tracheostomies also learn to keep the stoma and tube dry and clean, and to avoid putting anything into the tube that does not belong.
Caring for a Tracheostomy
Routine care for a tracheostomy involves practices to maintain hygiene and prevent complications.
Cleaning the stoma and the tracheostomy tube’s inner cannula is a daily requirement to prevent infection and skin irritation. This involves cleaning the skin around the stoma two to three times a day to remove dried mucus and prevent rashes.
Suctioning clears mucus and secretions from the trachea and lower airway. A suction catheter is inserted into the tracheostomy tube and connected to a suction machine. Recognize signs indicating a need for suctioning, such as visible mucus, rattling sounds, or difficulty breathing, and avoid suctioning too frequently.
Changing tracheostomy ties or dressings is also part of routine care, which helps secure the tube and keep the area clean. Individuals and caregivers are taught to recognize signs of potential complications, such as increased pain, swelling, redness, pus drainage, or fever, and to seek medical attention if the tube becomes blocked or dislodged.