Overview

Why is it necessary?

A tracheostomy is sometimes needed if you're unable to breathe normally because of an underlying health condition or a blocked airway.

Breathing problems

A tracheostomy can deliver oxygen to the lungs if you can't breathe normally. This is known as respiratory failure.

Conditions that can lead to respiratory failure and the need for a tracheostomy include:

• being unconscious or in a coma as a result of a severe head injury or stroke
• an inability to move 1 or more muscles (paralysis) after a serious spinal cord injury
• a condition that damages the lungs, such as pneumonia or cystic fibrosis
• a condition that damages the nervous system, such as motor neurone disease or Guillain-Barré syndrome

Sometimes, a tube attached to an artificial breathing machine (ventilator) is inserted into the mouth and down the throat.

But this can be uncomfortable, so a tracheostomy may be carried out if you need help breathing for more than a few days.

Blockages

A tracheostomy can also be used to bypass an airway that's become blocked as a result of:

• accidentally swallowing something that gets stuck in the windpipe (trachea)
• an injury, infection, burn or severe allergic reaction (anaphylaxis) that causes the throat to become swollen and narrowed
• swelling after head or neck surgery
• a cancerous tumour – this can sometimes happen with mouth cancer, laryngeal cancer or thyroid gland cancer

In addition, some children born with birth defects that cause their airways to be abnormally narrow may need a tracheostomy to help them breathe.

Removing fluid

It may be necessary to carry out a tracheostomy to remove fluid that's built up in the airways.

This may be needed if you:

• are unable to cough properly because of chronic pain, muscle weakness or paralysis
• have a serious lung infection, such as pneumonia, that has caused your lungs to become clogged with fluid
• your airways or lungs have filled with blood as a result of an injury

Living with

It's possible to enjoy a good quality of life with a permanent tracheostomy tube.

However, some people may find it takes time to adapt to swallowing and communicating.

Your care team will talk to you about possible problems, the help that's available, and how to look after your tracheostomy.

Speech

It's usually difficult to speak if you have a tracheostomy. Speech is generated when air passes over the vocal cords at the back of the throat.

But after a tracheostomy most of the air you breathe out will pass through your tracheostomy tube rather than over your vocal cords.

One solution is to use a speaking valve, which is an attachment that sits at the end of the tracheostomy tube and is designed to temporarily close every time you breathe out. This prevents the air leaking out of the tube and allows you to speak.

It can take a while to get used to speaking with the valve. You may be referred to a speech and language therapist for advice and training to help you learn to speak while the tracheostomy tube is in place.

Eating

Most people will eventually be able to eat normally with a tracheostomy, although swallowing can be difficult at first.

While in hospital, you may start by taking small sips of water before gradually moving on to soft foods, followed by regular food.

If you have swallowing difficulties, a speech and language therapist can teach you some techniques that may help.

Physical activity

After having a tracheostomy you should be able to continue doing everyday activities, but should avoid vigorous activities for about 6 weeks after the procedure.

It's very important to keep the opening of your tracheostomy clean and dry when you're outside. The opening will usually be covered with a dressing.

You could also wear a loose piece of clothing, such as a scarf, to stop things like water, sand or dust entering the opening and causing breathing problems.

Cleaning the tracheostomy tube

A tracheostomy tube needs to be cleaned regularly to stop it becoming blocked with fluid and mucus. This may need to be done several times a day.

A specialist tracheostomy nurse will teach you how to take care of your tracheostomy tube before you leave hospital, including how to suction fluid from your windpipe (trachea) and how to clean and change the tube.

Complications

A tracheostomy is usually safe and straightforward but, as with many medical procedures, it does carry a risk of complications.

The likelihood of complications will depend on:

• your age and general health
• the reason you need the tracheostomy

Generally, a planned tracheostomy carries a lower risk of complications than an emergency tracheostomy.

Early complications

There are some complications that can happen during or shortly after a tracheostomy.

Bleeding

It's common for there to be some bleeding from the windpipe (trachea) or the tracheostomy itself.

It's usually minor and improves within a few days, although in some cases it can be significant and a blood transfusion may be necessary.

Collapsed lung

Sometimes air will collect around the lungs and cause them to collapse inwards. This is known as a pneumothorax.

If it's mild, it often corrects itself without treatment. If it's more serious, surgery will be needed to implant a tube into the chest to drain the air away.

Accidental injury

The nerves near the windpipe can be accidentally damaged, such as those controlling the voice box (larynx) or the tube that runs from the back of the throat to the stomach (oesophagus). This may cause problems with speaking and swallowing.

Infection

The windpipe or nearby tissues can become infected. If this happens, treatment with antibiotics is usually needed.

Late complications

Some complications can happen days, weeks or even months after a tracheostomy.

Failure to heal

Sometimes the tracheostomy wound does not heal properly and starts to bleed.

If this happens, the tracheostomy tube may need to be temporarily removed so surgery can be carried out to stem the bleeding.

Blocked tracheostomy tube

There is a risk that the tracheostomy tube could become suddenly or gradually blocked with mucus and fluids if you're unable to clear your airways by coughing.

This risk can be reduced by ensuring the tube is cleaned regularly and any fluid is suctioned out.

Collapsed windpipe

Sometimes, the windpipe collapses in on itself because its walls are not strong enough to support it.

This usually happens when the tracheostomy tube has not been fitted properly. Treatment involves further surgery.

Narrowed windpipe

Accidental damage to the throat can result in the airways becoming scarred and narrowed, which can cause breathing difficulties.

Surgery may be needed to widen the airways. This may involve implanting a small tube called a stent to hold the airways open.