You may have many questions about the future if you or a loved one has recently had a tracheostomy while in the hospital. Everyone’s experience as to why they needed a tracheostomy in the first place and what their future looks like will differ. Many people live for a long time with a tracheostomy. However, having one usually requires several adjustments to your lifestyle and careful planning to ensure adequate care.
We will discuss what a tracheostomy is, why it would be needed, ways to cope, and some standard terms associated with a tracheostomy. We hope you will find this information beneficial as you or a loved one navigates through life with a tracheostomy, whether it is a temporary or permanent solution.
What is a Tracheostomy?
A tracheostomy is an opening in the front of the neck that’s made during an emergency or planned surgery. A tube is inserted into this opening in the trachea, or windpipe, for the person to breathe. This opening makes an airway for those who cannot breathe independently or have a blockage affecting their breathing. If a disease, such as cancer, is expected to cause difficulty breathing, a tracheostomy may be needed.
The tracheostomy opening is a kind of stoma that looks similar to the lining inside of the cheek. The stoma is pink or red and will be a hole in the front of the neck. Because a tracheostomy helps someone breathe, the larynx, or voice box, remains in place.
With a tracheostomy, if a person’s lungs still function well, they breathe through the tube directly in the trachea instead of breathing through their nose and mouth. If a person’s lungs are not working correctly or are affected by a disease, assistance from a breathing machine can help push air in and out of the tracheostomy tube.
What are the Reasons For a Tracheostomy?
There are three main reasons a tracheostomy is performed:
- The upper airway is obstructed
- To remove and clean the airway from secretions
- To deliver more oxygen to the lungs
There are many reasons why sufficient air cannot get to the lungs, and a tracheostomy must be performed.
Airway Problems That May Require a Tracheostomy
- Tumors in the throat or neck area
- A large tongue or a small jaw that blocks the airway
- Infection that causes swelling inside the trachea
- Laryngectomy (removal of the vocal cords)
- Tracheomalacia (collapse of the airway)
- Vocal cord paralysis caused by nerve damage or disease
- Blunt or severe trauma to the throat, neck, or mouth
- Congenital abnormalities of the airway
- Inhalation of corrosive material, smoke, or steam that burns the airway
- Obstructive sleep apnea
- Obstruction from a foreign body
Lung Problems That May Require a Tracheostomy
- Chest wall injury
- Chronic pulmonary disease – the lungs become inflamed and obstruct airflow
- Bronchopulmonary Dysplasia – abnormal development of the lungs of infants that causes a breathing disorder and causes the need for prolonged respiratory support
- Dysfunction of the diaphragm
Other Situations That May Require a Tracheostomy
- Fracture of cervical vertebrae with spinal cord injury
- Neuromuscular diseases paralyzing or weakening the diaphragm and chest muscles
- Aspiration related to muscle or sensory problems in the throat
- A severe allergic reaction
- Long-term coma or unconsciousness
- Facial surgery and facial burns
- Other emergencies when breathing is obstructed, and emergency personnel can’t put a breathing tube through the mouth and into the trachea
Is a Tracheostomy Permanent?
A tracheostomy can be either temporary or permanent, depending on the problem being treated. If a medical issue needs to be resolved, a tracheostomy provides an alternate breathing route and is meant to be temporary. However, a tracheostomy may be the best permanent solution if a person needs to remain indefinitely connected to a ventilator.
If the plan is for a tracheostomy to be temporary, the length of time it is left in place depends on why it was done and how long that problem will take to get better. For example, if a patient needs help from a breathing machine, the issue that caused the tracheostomy will need to heal or be fixed before the tracheostomy can be removed. If the tracheostomy was done due to a blockage, injury, or disease, the tube would probably be needed for an extended period. A tracheostomy could be in place for the rest of the patient’s life if part of the trachea is required to be removed or if it doesn’t get better. The hole may close and heal on its own, or it can be closed surgically.
What to Expect After Tracheostomy Surgery?
After tracheostomy surgery, several days will be spent in the hospital as your body heals. Learning skills necessary for maintaining and coping with your tracheostomy during this time are essential.
While you are in the hospital:
- Learn how to care for your tracheostomy tube. Cleaning and changing your tracheostomy tube helps prevent infection and reduces the risk of complications. Your team of nurses will help train you on how to care for your tracheostomy tube.
- You may need help speaking. A tracheostomy usually prevents speaking because exhaled air goes out of the tracheostomy opening rather than through your voice box. Speaking with the tube in place is dependent on the type of tube, the width of your trachea, and the condition of your voice box. A speech therapist or trained tracheostomy care nurse will discuss options for communicating and help you learn to use your voice again.
- Eating will be difficult. Swallowing will be difficult after a tracheostomy. You will receive nutrients through an intravenous (IV) line, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. It may take some time and patience to regain the muscle strength and coordination needed for swallowing.
- Discuss ways to cope with dry air. After a tracheostomy, the air you breathe will be much drier because it no longer passes through your moist nose and throat before reaching your lungs. You may experience episodes of coughing or excess mucus coming out of the tracheostomy. Secretions can be loosened by putting small amounts of saline directly into the tracheostomy tube. Having a humidifier or vaporizer in the room can also be beneficial, as they add moisture to the air.
When you get home:
- Get plenty of rest. Getting enough sleep will help you recover and remember not to overdo it.
- Plan for time off work. Depending on the type of work you do, plan on taking about two weeks off. Even if you work from home, focus on your healing, and take it easy. You never know how you will feel and what health issues may arise once you get home.
- Fit in a little exercise. Try to get in a walk each day. Start slow and work your way up to longer times. Avoid anything strenuous like running or lifting weights. Walking is best and boosts blood flow, which helps prevent constipation and pneumonia.
- Bathe carefully. Stick to bathing in a shallow bathtub and try to avoid splashing water into your trach. You can also try showering, but aim the stream away from your tracheostomy. Bacteria can quickly enter the tracheostomy, and you don’t want to get an infection. It would be best if you did not swim with a tracheostomy.
- Eating. You should be able to eat without a problem, but if food or liquid gets into your tracheostomy tube, suction it out right away. It is helpful to sit up while you eat. The suction canister kit by Cardinal Health is an excellent option for this.
- Drinking. Staying hydrated is also very helpful, so try to make sure your fluid intake is sufficient.
- Regular bowel movements may be off. It is common to experience irregular bowel movements after surgery. Taking a fiber supplement or mild laxative may help move things along. However, if you have not had a bowel movement after a couple of days, you will need to contact your doctor.
- Your stomach may become upset. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
What Kind of Food Can You Eat With a Tracheostomy?
Eating and swallowing patterns are usually not affected by having a tracheostomy. When you get your tracheostomy tube, you may be first started on a liquid or pureed diet. Once the tracheostomy tube is switched for a smaller size, swallowing is more comfortable. If there is a concern that your swallowing is impaired, nutrients will be administered through IV (an intravenous catheter placed in a vein) or a feeding tube.
Once you have healed from surgery, your doctor will inform you when it is safe to advance your diet to take in solids and liquids by mouth. At this time, a speech therapist will also help you learn how to swallow with a tracheostomy tube.
Certain factors may make swallowing difficult, such as:
- Not having eaten for an extended period
- Changes in the structure of your airway
- The health condition that caused the tracheostomy in the first place
Tips for Eating and Swallowing
Here are a few tips that may help with swallowing problems:
- Make sure to suction the tracheostomy tube before eating to prevent coughing while eating that could lead to throwing up.
- If your tracheostomy tube has a cuff, ensure the cuff is deflated when you are getting ready to eat for easier swallowing.
- Sit up as straight as possible when you eat.
- Take small bites, chew food thoroughly, and swallow before taking another bite.
- Keep mealtimes relaxed by planning them so that you are not in a hurry. Turn the tv off and put your cell phone away.
Common Terms Associated With a Tracheostomy?
Having a tracheostomy procedure done on you is a scary and life-changing event. However, it is a necessary procedure that will save your life. Thus, it is essential to know these terms and have an idea of terms that you will hear once you’ve had this procedure done.
Trach Tube – The tracheostomy tube or trach tube is a tube that is inserted into the trachea to provide a channel for air to pass through
Inner Cannula – A tracheostomy may or may not have an inner cannula, a liner that can be locked into place and then unlocked so it can be removed and cleaned.
Cuffed and Uncuffed Tracheostomy Tube – The cuff is a seal that inflates inside the trachea to block air from leaking around the tube. It forces all air going in and out of the lungs to go through the tube and stops saliva and other liquids from accidentally reaching the lungs.
- A cuffed tube is often used when a patient is on a ventilator or needs help from a breathing machine. The healthcare team monitors the cuff pressure, and adjustments are made to the breathing machine as needed.
- Uncuffed tubes are used for patients who do not need a ventilator or help from a breathing machine. With an uncuffed tube, some air can still flow around the tube and up through the trachea to the larynx.
Trach Cover – To prevent dust and dirt from accumulating, the trach tube is kept protected using a trach cover.
Trach Tube Holder, Collar, or Tie – Any of these three terms are used to describe devices that hold the tracheostomy tube in place. A trach tube holder or trach tube collar has a firmer hold while trach ties can be adjusted and are cheaper.
Passy Muir Valve – The Passy Muir valve helps the patient speak more normally and goes on the outside opening of the tracheostomy tube. It opens when air is breathed in and closes when air is breathed out. The Passy valve is also called a Passy-Muir speaking valve.
Stoma Shield Cover – The stoma shield cover is an essential protective device that guards the tracheostomy hole against water during showers.
Trach Heat Exchanger – This device heats and humidifies the air that comes into the trachea. A trach heat exchanger is an expensive approach to coping with dry air after tracheostomy surgery.
Tracheostomy Cleaning Tray – This is a single-use kit that includes everything needed to clean and prep the whole tracheostomy system. A complete tracheostomy tray should include latex gloves, gauzes, and other essential materials used to clean the entire tracheostomy system. It is a single-use kit.
Whether you’ll be having a tracheostomy temporarily or for life, it is essential to become acclimated with these devices to maintain yourself. Try to ask as many questions as possible while you are in the care of your doctor and nurses to help get as much information as possible before you head home.
For questions related to the tracheostomy supplies we carry, our Personally Delivered Product Experts are just a phone call away and ready to help.