Tracheostomy is a surgical treatment to connect a tube directly into the trachea (windpipe) to assist breathing. It may be performed for severe breathing difficulties, respiratory failure, a blocked windpipe or to enable mechanical ventilation.
In a tracheostomy procedure, a small hole is cut in the front of the windpipe or trachea through an incision in the neck to allow a special tube to be passed through.
A tracheostomy is usually carried out for adults or children who need a long period of mechanical ventilation or breathing support. The tube can also be used to remove any build-up of fluid from the windpipe.
The trachea is a tube around 10cm long and less than 2.5cm in diameter in most people.
The trachea begins just under the larynx (voice box) and runs down behind the breastbone (sternum). The trachea then divides into two smaller tubes called bronchi: one bronchus for each lung.
The trachea is composed of about 20 rings of tough cartilage. The back part of each ring is made of muscle and connective tissue.
A scalpel or special needle is used by a doctor to make a hole in the windpipe for the breathing tube or fluid removal tube.
The tracheostomy may be planned in advance or carried out in a medical emergency, for example if a blocked airway is stopping the person from breathing.
General or local anaesthetic may be used and the placement of the tube may be temporary for short-term conditions or permanent for long-term medical conditions.
An X-ray is sometimes used to make sure the tube is in the correct place. A dressing keeps the external part of the tube in place and sterile.
Once the tube is inserted, it will be more difficult for the person to speak, but this can be helped with the use of an additional speaking valve on the tube and sometimes help from a speech and language therapist.
The tracheostomy affects swallowing, so eating is affected and diet changes may be needed.
The tracheostomy tube needs to be kept clean to avoid blockages. Homecare instructions may be given. Outdoors, wearing a scarf can help protect the tube and dressing.
Complications of a tracheostomy include collapsed lung, bleeding, infection and accidental injury to the voice box during insertion of the tube.