What is a tracheostomy?

A tracheostomy, also known as a tracheotomy, is a small surgical opening that is made through the front of the neck into the windpipe, or trachea.

A curved plastic tube, known as a tracheostomy tube, is placed through the hole allowing air to flow in and out of the windpipe. The tube does not extend into the lungs.

The tube allows the person to breathe through the throat, bypassing their upper airway, including their nose and mouth. A tracheostomy may be temporary or permanent, done as an emergency or done as a planned procedure.

Why is a tracheostomy performed?

A tracheostomy is performed when an adult or child has a condition that makes normal breathing difficult or impossible.

People have tracheostomies for many different reasons, including:

• neurological conditions such as stroke or tumours
• severe injuries to the head and neck
• spinal injuries
• burns
• severe pneumonia
• acquired and congenital subglottic stenosis (a condition where the windpipe is narrowed)
• severe allergic reactions (anaphylaxis)
• head and neck cancer
• radiation therapy to the head and neck
• severe lung disease

What does a tracheostomy involve?

A tracheostomy is usually performed under a combination of local and a light general anaesthetic.

A small incision is made in the throat and a tracheostomy tube is inserted into the windpipe. The tube sits in the windpipe and is tied in with tape. At first, there might be a few stitches, but these are usually taken out within a week.

After the procedure, most people spend some time in the intensive care unit. This is to make sure that the wound is healing well and the tube can be changed safely.

Many people can start eating and drinking by mouth again once the tracheostomy has stabilised. This may be a week or 2 after the procedure. Some people need to be fed by tube.

It is normal for people having a tracheostomy to feel anxious and fearful. People report having many complex feelings and physical sensations when they have a tracheostomy.

What happens after a tracheostomy?

Nurses, physiotherapists, dietitians and speech therapists work together to help care for people who have a tracheostomy.

After surgery, nurses may need to suction mucous out of the tube. Physiotherapists can help keep the lungs clear of mucus, and speech therapists can help with swallowing and speaking.

The tracheostomy tube needs to be changed regularly. People who go home with a tracheostomy might be given instructions on how to care for and change the tracheostomy tube. Sometimes they need to come back to hospital to have the tube changed.

What are the risks and side effects of tracheostomy?

The risks of tracheostomy can include:

• bleeding and damage to the throat
• blockage of the tube with secretions, which can be breathed into the lungs causing pneumonia (aspiration pneumonia)
• infection
• tube displacement
• scar formation

Rarer risks include:

• narrowing of the windpipe
• a hole forming between the windpipe and the food pipe
• windpipe tissue death (tracheal necrosis)
• a granuloma forms (a small area of inflamed tissue)

What are the alternatives to a tracheostomy?

Tracheostomies are usually performed as a last resort. If there are other options suitable, your doctor will likely recommend them instead. In an emergency situation, a tracheostomy could save your life.

Where to get help

If you have questions about a tracheostomy, speak to:

• your surgeon
• your doctor
• a nurse who is trained in tracheostomy care