What is a Tracheotomy?
A tracheotomy is an opening into the trachea (windpipe) and inserting a tracheostomy tube helps to keep it open. The tube is held in place by soft Velcro straps or ties that are tied around the neck. The opening or hole in your neck, into which the tracheostomy tube is inserted is referred to as a stoma.
It is important that you keep the tracheostomy tube in place except for a very short time when it is being changed. Without a tracheostomy tube in place the opening or stoma will close naturally.
Why do I need a Tracheotomy?
A tracheotomy is performed to make breathing easier and may be required for many different reasons:
1. Obstruction of the upper airways
Breathing becomes difficult or noisy because air cannot pass from the nose and mouth through the voice box and trachea (windpipe) to the lungs.
2. Respiratory failure / Respiratory Support
This is where the lungs are not working properly and a tracheostomy can reduce the effort needed for breathing. Sometimes it is necessary to have the help of a machine in order for the lungs to work more effectively. This is called a ventilator.
3. Excessive chest secretions
A tracheostomy provides an opening into the windpipe and makes it easier to remove chest mucus using special suction equipment. This makes breathing much easier.
4. Major surgery of the head and neck areas.
Planned surgical operations on the head and neck areas may cause swelling to tissues internally and may cause obstruction of the flow of air. This makes breathing through the nose and mouth very difficult. Therefore for a short period after surgery a tracheostomy will be required until the healing takes place and swelling resolves. Your consultant will discuss this with you.
5. To protect the chest when swallowing reflexes are missing.
This is when the swallowing mechanisms are not working properly and there is a chance of food contents and drinks being inhaled into the windpipe and lungs.
Will I always have a Tracheostomy?
A tracheostomy can be removed and the opening will naturally close once the tracheostomy tube is not present. However the problem which required you to have the tracheostomy will need to be resolved. Your consultant will discuss this with you.
How is the operation performed?
There are two ways of inserting a tracheostomy.
1. Surgical tracheostomy
A surgical tracheosotomy is almost always undertaken in an operating theatre. The operation can be undertaken under a local anaesthetic (when you remain awake and the neck area is numbed) or a general anaesthetic (where you are fully unconscious). Your consultant will discuss this with you. The operation takes about 45 minutes.
To prevent vomiting and other complications during the operations it is necessary for you to starve (have nothing by mouth or no chewing gum) for at least 6 hours before the operation. You will be advised of what time to starve from when you attend the pre-admission assessment.
2. Percutaneous Tracheostomy
This is usually performed in the Intensive Care Unit
Will I be able to speak after the operation?
You may not be able to speak immediately after the surgery and this is because the tracheostomy has a little inflated balloon on the inside, Called the cuff, which means air will not pass through the mouth and nose. This balloon is inflated to ensure that any bleeding caused while inserting the tracheostomy tube is not inhaled into the lungs. Once the balloon is deflated then it may be possible to talk by covering the tracheostomy tube with a finger or using a speaking valve. The doctors and nurses will discuss this with you. You will be shown how to talk and use a speaking valve.
There will always be a way in which you can communicate, such as sound, gestures, writing or other people reading your lips. All the hospital and community staff are dedicated to help and support you and your family to a new way of communication.
Who will be involved in my Care?
You and your family may like to find out about what having a tracheostomy really means. You will meet several health professionals before your operation as well as the doctors and nurses.
Head and Neck Macmillan Nurse / Tracheostomy Specialist Nurse
The specialist nurses will provide both you and your family with information, support and advice concerning all aspects of your illness, treatment and recovery.
Speech and language therapist
The Speech and Language Therapist will help you develop new ways of communicating and teach you new skills. You will be invited to meet with a person who has already gone through this operation, and this may help you and your family more fully understand what to expect.
The dietician will give you advice on all your nutrition needs throughout your treatment and ensure these are met while you are recovering from your surgery.
The physiotherapist will help you with your breathing whilst recovering from your tracheostomy.
Head and Neck Counselor
The Head and Neck Counselor will help give you and your family psychological support through your surgery and treatment and give opportunity for structured counseling if necessary.
Hospital appointments before your Operation
You may be asked to attend a pre-treatment assessment where you will have a chance to meet and talk to the professionals involved in your care and discuss any issues you have with your treatment and recovery plan. You may be asked to complete some questionnaires in order for your professional team to assess any immediate needs, both physical and psychological, to prepare you and your family for surgery.
You may be invited to attend a pre-admission assessment one or two weeks before your operation. This enables both the doctors and the nurses to assess your health needs and carry out tests such as, blood tests, heart tracings (ECG) and chest X-rays. This ensures that it is safe for you to undergo a general anaesthetic. It is important that you bring any medication that you are taking for the medial staff to see.
The pre-admission assessment clinic is an opportunity for you to meet the ward staff and see where you will be admitted on the day of your operation. It is also a time when you can ask questions and discuss any queries you may have concerning your operation.