A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe.
If necessary, the tube can be connected to an oxygen supply and a breathing machine called a ventilator.
The tube can also be used to suction out any fluid that has built up in the throat and windpipe.
Why they're used
A tracheostomy may be created for a number of reasons, including:
to deliver oxygen to the lungs when a person is unable to breathe normally after an injury or accident, or because their muscles are very weak
to allow a person to breathe if their throat is blocked – this can be caused by a swelling, a tumour, or something stuck in their throat
to reduce the risk of food or fluid going into your lungs (aspiration) if you find coughing difficult
In many cases, a tracheostomy will be planned in advance and carried out in hospital, although sometimes it may need to be done in an emergency outside of hospital, such as at the scene of an accident.
How the procedure is carried out
Planned tracheostomies are usually carried out under general anaesthetic. This means you will be asleep during the procedure and won't feel any pain.
A doctor or surgeon will make a hole in your throat using a needle or scalpel before inserting a tube into the opening.
If it's an emergency, the tracheostomy will be carried out as soon as possible using local anaesthetic if there is not enough time to use general anaesthetic. This means you will be awake during the procedure, but shouldn't feel severe pain.
Afterwards, you'll need to stay in hospital for at least a few days or weeks. In some cases, it may be possible to remove the tube and close the opening before leaving hospital.
However, the tube may need to stay in permanently if you have a long-term condition that affects your breathing.
Living with a tracheostomy
It's possible to enjoy a good lifestyle with a permanent tracheostomy tube, but it can take some time to adapt. Most people will initially have difficulty with talking, eating, exercise, and keeping the tracheostomy tube clean and free of blockages.
If you or your child needs a tracheostomy, a specially trained therapist can give you advice and answer any questions that you have. They will make sure you feel confident about looking after the tracheostomy before you leave hospital.
Risks and complications
A tracheostomy is generally a safe and effective procedure. However, as with all medical procedures, there is a small risk of complications, including bleeding, infection, and breathing difficulties.
Why a tracheostomy may be needed
A tracheostomy is sometimes required when a person is unable to breathe normally because of an underlying health condition or a blocked airway.
A tracheostomy can deliver oxygen to the lungs when a person is unable to 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
paralysis (an inability to move one or more muscles) 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
In some cases, a tube attached to an artificial breathing machine (ventilator) will be inserted into the mouth and down the throat initially. However, as this can be uncomfortable, a tracheostomy may be created if breathing support is needed for more than a few days.
A tracheostomy can also be used to bypass an airway that has become blocked as a result of:
accidentally swallowing something that gets stuck in the windpipe (trachea), such as a piece of bone
an injury, infection, burn, or a 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.
In some circumstances, it may be necessary to create a tracheostomy to remove fluid that has built up in the airways. This may be needed when a person:
is unable to cough properly because of chronic pain, muscle weakness, or paralysis
has a serious lung infection, such as pneumonia, that has caused their lungs to become clogged with fluid
has an injury that has resulted in their airways or lungs becoming filled with blood
How a tracheostomy is formed
A tracheostomy may be formed during either a planned or emergency procedure.
Many tracheostomy procedures are performed in intensive care, where there is time to prepare for the procedure and explain what is happening.
A planned tracheostomy can be carried out in one of two ways:
a percutaneous tracheostomy
an open tracheostomy
A percutaneous tracheostomy is usually carried out under general anaesthetic (where you are asleep) in an intensive care unit.
Your doctor first makes a small cut (incision) in your throat, or inserts a thin needle through your throat and into your windpipe (trachea).
A wire is then passed into your windpipe through the needle or incision and is used to guide a specially shaped instrument called a dilator into the opening.
The dilator helps open up the hole in your throat and windpipe so a tracheostomy tube can be inserted.
In some cases, a thin telescope (endoscope) is passed down your throat during the procedure so your doctor can make sure everything is in the right position.
An open tracheostomy is usually carried out in an operating theatre under a general anaesthetic.
The surgeon will make a cut in the lower part of your neck and part the tissues covering your windpipe. They will then make an incision in the wall of your windpipe so the tracheostomy tube can be inserted through the opening.
This technique is used when it is not safe or possible to perform a percutaneous tracheostomy. For example, it may be recommended:
for children younger than 12 years old
when the normal structure of the neck has been affected by something, such as a tumour or a collection of blood
when the person is very overweight and has a large amount of fat in and around their neck
After the procedure
After both procedures, an X-ray may be taken to check the tube is in the right position. Antibiotics may be prescribed to reduce the risk of an infection at the site of the incision.
If you are unable to breathe unaided, the tracheostomy tube can be attached to a ventilator (a machine that supplies oxygen to assist with breathing) to increase the flow of oxygen to your lungs.
When the tracheostomy tube is in position, a dressing is placed around the opening in your neck, and tape or stitches will be used to hold the tube in place.
An emergency tracheostomy may be needed if a person's airway suddenly or unexpectedly becomes blocked after an accident or injury, or if they have respiratory failure (a serious and life-threatening condition where the lungs cannot provide enough oxygen for the rest of the body).
An emergency tracheostomy is sometimes carried out using local anaesthetic if there is not enough time to use a general anaesthetic, or if the procedure is not being carried out in a hospital. If local anaesthetic is used, the person will be awake throughout the procedure but shouldn't feel severe pain.
The person will be placed on their back and a rolled-up towel or something similar will be positioned under their shoulders. This stretches out their neck, making it easier to see the structure of the throat.
A cut will be made in the skin of the neck and underlying tissue. The tracheostomy tube will be inserted into the airway and may be connected to a ventilator.
How long will I need a tracheostomy for?
For some people, the tracheostomy tube may be removed in hospital after a few days or weeks when they are able to breathe, protect their airway, and clear fluids unaided. For others, it may be permanent or needed for a longer time.
If the tube is temporary, the opening in your neck will be covered with a dressing when it's removed. This opening will usually take a few weeks to heal completely, and afterwards you may have a small scar where the opening was.
If you need a tracheostomy in the long term, you may be able to go home with the tube in place. Your care team will make sure you are confident about looking after your tracheostomy before you are discharged.
Living with a tracheostomy
It's possible to enjoy a good lifestyle with a permanent tracheostomy tube. However, some people may find it takes some time to adapt to swallowing and communication.
Your care team will talk to you about possible issues you may experience, the help that's available, and what you need to do to look after your tracheostomy.
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 that 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. However, 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.
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 off taking small sips of water before gradually moving on to soft foods, followed by regular food.
If you have any difficulties swallowing, a speech and language therapist can teach you some techniques that may help.
You should be able to resume everyday activities, but you should avoid vigorous activities for about six weeks after the procedure.
When you're outside, it's very important that your tracheostomy opening is kept clean and dry. The opening will usually be covered with a dressing, but a loose piece of clothing, such as a scarf, can also be worn over the top. This will stop substances such as water, sand or dust from 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 mucus or fluid. 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 of a tracheostomy
Creating a tracheostomy is considered to be a safe and straightforward procedure. But, as with many medical procedures, it does carry a risk of complications.
The likelihood of complications occurring 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.
Some of the complications that can occur during or shortly after a tracheostomy are outlined below.
It's common for some bleeding to occur from the windpipe (trachea) or the tracheostomy itself after a tracheostomy has been created.
This is usually minor and gets better within a few days, although in some cases it can be significant and a blood transfusion may be necessary.
Sometimes air will collect around the lungs and cause the lungs to collapse inwards. This is known as a pneumothorax. In mild cases, this often corrects itself without the need for treatment. In more serious cases, a tube will need to be surgically implanted into the chest to drain the air away.
The nerves near the windpipe can be accidentally damaged, such as those controlling the voice box (larynx) or the oesophagus (the tube that runs from the back of the throat to the stomach). This may cause problems with speaking and swallowing.
The windpipe or nearby tissues can become infected with bacteria. These usually need to be treated with antibiotics.
Some of the complications that can occur days, weeks or even months after a tracheostomy are described below.
Failure to heal
Sometimes the tracheostomy wound will 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 the person is unable to clear their airways by coughing.
This risk can be reduced by ensuring the tube is regularly cleaned and any fluid is suctioned out.
Sometimes the windpipe collapses in on itself because the walls of the windpipe are not strong enough to support it. This usually occurs when the tracheostomy tube has not been fitted properly, and it requires further surgery.
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 keep the airways open.