Tracheostomy (Tracheotomy)

What is a tracheostomy tube?

A tracheostomy tube is a small tube designed to be directly placed into a patient's windpipe through the neck. The surgical procedure of inserting a tracheostomy tube into a patient's windpipe is called a tracheotomy.

When is a tracheostomy needed?

A tracheostomy tube may be needed for ICU patients requiring long-term mechanical ventilation, patients unable to cough effectively to clear secretions, and patients with an obstructed or blocked airway. The decision to perform a tracheostomy on a particular patient depends upon the circumstances surrounding that patient and often follows use of breathing (endotracheal) tube.

How is a tracheostomy performed?

The tracheostomy can be performed in the operating room or at the patient's bedside. Typically light anesthesia is required during the tracheostomy procedure. The tracheostomy tube can be inserted either of two ways - the open technique or the percutaneous technique.

The open technique involves a small incision made in the lower part of the neck just above the windpipe (trachea). Subsequently, an incision is made in the windpipe (trachea) and the tracheostomy tube is inserted.

The percutaneous technique involves the formation of a small opening in the trachea that is gradually dilated to the size of the tracheostomy tube.

Either technique is an acceptable approach to inserting a tracheostomy tube in a critically ill or injured patient. After the tracheostomy tube is secured, the patient's breathing tube is removed.

The advantages of a tracheostomy tube over the breathing tube are: the patient is usually more comfortable, the patient may be able to drink or eat with the tracheostomy tube in place, and the tracheostomy tube may make it easier for the patient to breathe.

Most tracheostomy tube insertions performed on ICU patients are temporary. Patients may be able to speak with a tracheostomy tube in place once they are able to breathe spontaneously (i.e., are off the breathing machine [mechanical ventilator]).

How long is a tracheostomy used? /h3>

Sometimes tracheostomy tubes are used only for days, weeks or even months and then removed. Under other circumstances the tracheostomy tube may be left in place for the rest of the patient's life.

Does a tracheostomy hurt?

Numbing medicine (local anesthesia) or general anesthesia is used during tracheostomy tube placement. The procedure is usually associated with minimal to no discomfort.

Are there any potential complications associated with a tracheostomy?

The potential complications associated with the insertion of a tracheostomy tube are bleeding and infection. With time, tracheostomy tubes need to be replaced. This is accomplished by removing the existing tracheostomy tube and replacing it with a new tube through the existing opening in the windpipe. This is performed with little to no discomfort to the patient.

Mechanical ventilator tubing (from left) and suction catheter (from right) leading to tracheostomy