Tracheostomy is the surgical procedure that involves creating an opening in the front of the neck (tracheotomy) and inserting a tube into the trachea (windpipe). The tube is inserted through the cut in the neck below the vocal cords, which allows the air to pass into the lungs. A tracheostomy provides an air passage for breathing when the airways are severely obstructed or impaired.
A tracheostomy is often indicated when a patient is dependent on a mechanical ventilator for a long period of time. In some exceptional cases, an emergency tracheostomy is performed when the airway is suddenly blocked, such as traumatic injury to neck or face.
Why is a Tracheostomy performed?
A tracheostomy is usually performed during an emergency or when a disease or any other problem makes normal breathing impossible. The following conditions may require a tracheostomy:
- Birth defects of airway
- Neck Cancer
- Chronic lung disease
- Diaphragm dysfunction
- Facial burns or surgery
- Chest wall injury
- Paralysis of respiratory muscles
- Vocal cord paralysis
- Prolonged ventilator support
- Obstructive sleep apnea
- Larynx injury or Laryngectomy
How Tracheostomy is performed?
A tracheostomy is performed in an operating room. Before the procedure, the patient is given a local anesthesia.Based on the requirement of the patient, the surgeon can opt either of the two procedures for tracheostomy:
- Surgical Tracheotomy: During a surgical tracheotomy, the surgeon makes a horizontal incision through the skin at the lower part of the neck. The surgeon pulls back the surrounding muscles carefully; splits open a small portion of the thyroid gland and, expose the windpipe. In the windpipe, a surgeon creates an opening at a specific point and inserts a tracheostomy tube. A neck strap is attached at the end of the tube which keeps it from slipping out of the opening. Temporary sutures may be used to secure the neck strap.
- Minimally Invasive Tracheotomy: It is a typical procedure in which a surgeon makes a small incision near the base of the neck. A capsule containing a special lens is fed through the mouth of the patient to view the insides of the throat. This guides a surgeon to insert a needle into the windpipe to create an opening and to place the tube. A neck strap is attached to prevent the tube from falling out of the windpipe.
Risks Associated with Tracheostomy
Any medical procedure, in which the skin is broken, carries the risk of infection and excessive bleeding. The common complications of tracheostomy include:
- Bleeding from trachea
- Infection in surgical wound
- Change in position of the tube
- Abnormal tissue formation in trachea
- Damage to thyroid gland
- Erosion of the trachea
- Lung puncture and lung collapse
- Scar tissue in trachea
- Nerve injury which may cause paralysis
- Allergic reactions to medicines
- Collapsed windpipe
After the procedure, it is necessary to learn the skills for maintaining and coping with the tracheostomy.
- A nurse will teach the patient how to clean and change the tracheostomy tube to prevent infection.
- In general, patients on tracheostomy are unable to speak because the air is expired through the stoma rather than the larynx (voicebox). Nowadays, devices and techniques are available to redirect the airflow to produce speech.
- In patients with tracheostomy who have impaired swallowing, nutrition may be provided via a nasogastric intubation or though intravenous route.
- The air inhaled by a patient with tracheostomy is much drier than usual since it does not pass through the moist nose and throat before reaching the lungs. This dry air may cause irritation, cough and excess mucus production in the lungs. Small amounts of saline are instilled into the tracheostomy tube which helps loosen the respiratory secretions.