Tracheostomy

What is a tracheostomy?

A tracheostomy is a surgical procedure that creates an opening in your child's neck and windpipe (trachea). A tube is then placed in the opening to keep it open. The procedure helps get air to your child's lungs.

The terms tracheostomy, tracheotomy, and trach may be used to refer to both the surgical procedure and to the opening created by the procedure.

When is it used?

A tracheostomy may be done when your child has a problem with the airway. For example, it may be done to:

• Get air into the lungs when the airway is blocked.
• Get oxygen to the lungs more easily.
• Clear secretions from the airway.

Examples of when a trach may be needed are:

• Your child’s upper airway is blocked by swelling, an injury, a tumor, a foreign body, vocal cord problems, or a severe narrowing of the trachea.
• Your child has an injury to the neck, head, or spinal cord that affects the brain or nerves and the ability to control his or her breathing.
• Your child needs frequent suctioning of fluid from the airway.
• Your child will be on a breathing machine (ventilator) for a long time because of an illness or injury.

What happens during the procedure?

This procedure is usually done in an operating room or in an intensive care unit.

Your child will be given general anesthesia to keep your child from feeling pain during the procedure. General anesthesia relaxes the muscles and your child will be asleep. Then your healthcare provider will make a cut in the neck and windpipe. A tube will be put into the opening. The tube will be held in place with a band or laces around the neck.

What happens after the procedure?

The skin around the trach tube will start to heal and your healthcare provider will monitor your child for a few days. The tube will usually be kept in place for 5 to 10 days. After that a new tube may be used.

If your child is on a ventilator, the tube will have a balloon around it that keeps air from leaking. In this case your child will not be able to talk. If your child doesn’t need a ventilator, a smaller tube may be used that allows air to pass around it. Then your child may be able to talk.

If your child still has the trach when he goes home from the hospital, your provider will teach you how to care for it. This will include cleaning the trach site, suctioning, and changing the tube. This training will take some time. Your child may need to stay at the hospital until it is complete.

A tracheostomy may be temporary or permanent. If your child no longer needs it, your provider will remove the tube and cover the stoma with a dressing. Your provider will tell you what type of dressing or bandage to use and how often to change it. If the opening hasn’t closed by itself by 4 to 6 months after the tube is removed, your provider may close it with minor surgery.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• bleeding
• infection
• damage to the voice box (larynx)
• problems with swallowing

When should I call my child’s healthcare provider?

Call 911 or your provider right away if:

• You cannot put a new trach tube in the opening after removing the old one. (While you wait for medical care, put a suction catheter 2 inches, or 5 cm, into the stoma and tape it to the skin. This will keep the stoma from shrinking too much and will allow medical staff to pass a tube over the catheter.)
• You see a lot of bleeding around the tracheostomy. (There may be a small amount of bleeding with a trach tube change but it should stop within a few minutes.)
• Your child cannot breathe easily after suctioning and changing the trach tube. For example, your child has shortness of breath, uncontrollable coughing, or trouble getting air in or out.

Call during office hours if:

• The secretions are yellow or green, are thicker than usual, or have an unusual or bad smell. (The first 1 or 2 hours in the morning, the secretions may be yellowish, but they should soon become a clear or white color.)
• Your child has changes in swallowing or breathing, sounds from the trach tube, or coughing that is not relieved by suctioning.