Tracheostomy

A tracheostomy (say "trayk-ee-AW-stuh-mee") is surgery to put a breathing tube directly into your windpipe (trachea). This tube helps you breathe when something is making it difficult or impossible to breathe through your nose or mouth. For example, it may be done if you have throat cancer, a lung or nerve problem, trouble handling secretions, or something blocking your airway, or if you injured your mouth or neck. The terms tracheostomy, tracheotomy, and "trach" (say "trayk") are all used to talk about the surgery itself and the opening created by the surgery. The opening is also called a stoma.

You may need a trach for a short time. Or you may need a trach permanently.

During the surgery, the doctor makes a few small cuts (incisions) to create an opening in your neck. Then the doctor puts a breathing tube through the opening and into your trachea. This tube, called a tracheostomy or trach tube, makes it easier for air to get to your lungs. It also helps remove mucus and other fluids from your lungs.

After the trach tube is put in, the opening may be left open. Or it might be made smaller around the tube with stitches or clips. If you no longer need the tube, the doctor will remove it. You will have a small scar on your neck that fades over time.

You may get medicine so you will be asleep during the surgery. Or you may be awake, but you will get medicine so you don't feel pain.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start out by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as biking, jogging, weight lifting, and aerobic exercise, for 6 weeks.
• You may take a bath in shallow water. Do not splash water into your trach.
• You may take a shower. Aim the showerhead at your lower body or back. Cover the tube so that no water gets in but you can still breathe.
• Do not swim.
• The doctor will help you decide how much time you will need to request off work. Once you are ready to return to work, the doctor will complete any paperwork to ensure your return. It can also depend on the type of work you do, your employer, your ability to speak, how you feel, and other health problems you may have.

Diet

• Eating and speaking may require the use of a special valve.
• If food or liquid gets into your tracheostomy tube, suction it out right away. Sit up while you eat.
• If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, take an over-the-counter medicine such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines contain acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor tells you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision, stoma, and tube care

Your doctor or nurse will give you instructions on how to take care of your trach. This will include knowing the size of your trach, how to suction your trach, how to clean the opening in your neck (stoma), and how to clean and replace your trach's inner tube (inner cannula). Be sure to follow all of your doctor's instructions closely. And remember to have your emergency supplies such as your obturator ready and available wherever you are.

• Suctioning Suctioning is needed if you can't clear mucus and secretions from your trach tube by coughing. Always have suction supplies ready, including a fully charged suction machine. Suction the trach as often as your doctor recommends or as needed. You will need suction catheters, a suction machine, and a mirror. These should be delivered to your home before you arrive there. Here are the steps to take:
  • Wash your hands with soap and water for at least 30 seconds.
  • Connect to oxygen for 30 to 60 seconds before suctioning.
  • Connect a catheter to the suction machine tubing. Insert the catheter into the trach. Push the tube in gently to the premeasured length.
  • Slowly pull the catheter out of the trach, rolling it back and forth between your fingers, with your thumb over the control valve (this turns the suction on). Do not keep the suction on for more than 10 seconds at a time.
  • Wait about 30 seconds, and repeat inserting and pulling out the tube until all the mucus has been removed.
  • Catheters can be used again if you clean them properly. Ask your doctor how to do this. Throw away used catheters if your doctor tells you to. Connect to oxygen after suctioning. Wash your hands again.
• Stoma care Clean and dry the stoma 2 times a day, and as needed. Apply ointment to keep the skin healthy. Do not let crust form on the skin at the stoma. You will need saline fluid or sterile water, 8 or 10 cotton-tipped swabs, gauze pads, a small cup, a dry cloth, a mirror, presplit gauze, and ointment for the skin. Follow these steps:
  • Wash your hands with soap and water for at least 30 seconds.
  • Fill the cup with the saline fluid or sterile water. Dampen a gauze pad or cotton-tipped swab and squeeze out any excess liquid from the gauze.
  • Clean and remove dried mucus around the stoma with the damp gauze pad or cotton-tipped swabs. To prevent spreading an infection, wipe the gauze or swab only once and then throw it away. Repeat with new, sterile material until the skin is clean. Be sure to look for any changes to the area, such as changes in color or swelling.
  • Dry your skin with a clean gauze pad. If your doctor tells you to use skin ointment for your stoma, apply it with the remaining cotton-tipped swabs. If needed, use a new, presplit gauze to protect the skin.
  • Wash your hands again.
• Cleaning the inner cannula If you are not using the disposable type of cannula, clean and replace the inner cannula 2 times each day and as needed. You will need 2 small bowls, a small cannula pipe brush, sterile water or saline fluid, and a mirror. To clean the inner cannula:
  • Wash your hands with soap and water for at least 30 seconds.
  • Pour a small amount of sterile water or saline fluid into both bowls.
  • Unlock the inner cannula from the trach and remove it by gently turning it counterclockwise then pulling it out and down. Put the reusable inner cannula into the first bowl. (If the inner cannula is disposable, throw it away and replace it with a new inner cannula.) Clean the inside and outside of the reusable inner cannula with the brush.
  • Rinse the cannula in the second bowl. Shake the cannula out, and slide it gently back into the outer cannula. Make sure the cannula is locked in place and you cannot pull it out.
  • Wash your hands again.

Other instructions

• Wear clothes that are loose around your neck.
• If you are outside, wear a loose covering over your trach, such as a scarf or other cloth, but avoid clothing with loose fibers. Covering your trach prevents dust, dirt, and bacteria from getting into it. You can also use special trach "bibs" to cover your trach and to protect your clothing from mucus when you cough. You can buy trach bibs at a medical supply store.
• Try not to breathe in anything that might irritate your trach. This includes small bits of food, smoke, powders, aerosol sprays, and dust.
• Keep the air in your home moist with a room vaporizer or humidifier. Follow the directions for cleaning the machine.
• Carry an extra cannula and obturator with you at all times, in case your tube becomes blocked.