Tracheostomy in Tampa and Spring Hill, FL
A tracheostomy helps patients breathe after a traumatic injury or as the result of a medical condition. Common reasons for a tracheostomy are the facilitation of the long-term use of a ventilator, allowing breathing when the airway is obstructed and some neurological conditions. Knowing when to recommend a tracheostomy requires the expertise of the board-certified Otolaryngologist/Head and Neck Surgeons of Suncoast ENT Surgical Specialists. We serve the communities of Tampa, Spring Hill and surrounding towns in Florida.
Perhaps you have seen someone with a tracheostomy, but you may not have understood why the procedure is necessary or how it is performed. A tracheostomy is a surgical procedure that involves making a hole in the neck to access the airway, specifically the windpipe. While some people only need a tracheostomy for a short period of time, others need a tracheostomy for the rest of their lives.
A tracheostomy is recommended for a number of reasons. In the most extreme cases — such as a sudden, traumatic injury to your neck — a tracheostomy will be performed to bypass the airway blockage caused by a sudden, traumatic injury. However, any type of blockage to the airway will require a tracheostomy at some point. When a person is on a ventilator (or another type of breathing machine that provides artificial respiration) for an extended period of time, a tracheostomy may be performed to prevent the larynx (voice box) from being damaged due to the pressure that the breathing tube places on the vocal cords for an extended period of time.
In general, the following situations will call for a tracheostomy insertion:
- When a ventilator is prescribed to a patient for more than two (2) weeks.
- When a medical condition, such as throat cancer or vocal cord paralysis, obstructs the airway.
- When neurological conditions make it difficult for you to expectorate the secretions from your throat, causing you to manually suction your trachea (windpipe) to clear the airway.
- When you’re preparing for surgery to your head or neck and require breathing assistance.
- When you experience severe trauma to your head, face, or neck that causes airway obstruction.
- Whenever there is any type of emergency situation that obstructs your airway, and emergency medical technicians cannot insert a breathing tube into your mouth.
How is a Tracheostomy Performed?
A tracheostomy is most commonly performed under general anesthesia and in an operating room. However, if the surgeon is concerned that the patient will not react well to general anesthesia, or there isn’t enough time to get the patient to an operating room (thus causing the procedure to be performed in a regular hospital room), the surgeon may opt for a local anesthetic in its place and stead.
During the procedure, a surgeon makes a horizontal cut through the skin at the bottom of the neck. The surrounding muscles are then pulled back, and a small incision is made into the thyroid gland, which will expose the trachea. Finally, the surgeon looks for a specific spot on this incision — located near the base of your neck — where he will create a hole where the tracheostomy tube will be inserted. Following the completion of this process, a faceplate and a neck tube will be attached to prevent the tracheostomy from slipping out of the hole; if necessary, a few temporary sutures will also be used to keep the faceplate in place on the skin of the neck.
What to Expect With a Tracheostomy
Expect to spend several days in the hospital after you finish getting your tracheostomy. During this time, you can expect that the tracheostomy will heal, and you will learn what you need to do in order to care for, and maintain, your tracheostomy.
Caring For Your Tracheostomy Tube
You will need to care for your tracheostomy tube at least twice a day. During your stay in the hospital, a nurse will show you the proper way. You will need to do this for as long as you have a tracheostomy tube, in order to prevent infection.
There will, however, be one challenge that you have to consider: speaking. When you get a tracheostomy, the air in your lungs will exit through your tracheostomy hole, rather than up through your larynx. You may be able to speak normally, however, depending on the condition of your voice box, the size and shape of the tracheostomy tube, and the diameter of your trachea. For those that are unable to speak due to the tracheostomy tube, however, there are devices and techniques that will be able to help you redirect your air so that speech is possible. A nurse and/or a speech therapist will work with you to teach you these techniques.
Eating will also prove to be a challenge. For as long as you have your tracheostomy tube, you will be required to obtain your nutrients through an IV or through a feeding tube. You may also receive your nutrients through a tube inserted directly into your stomach. When you have your tracheostomy tube removed, you will be required to meet with a speech therapist to help you redevelop your muscles that will help you swallow again.
Finally, you will have to have a device put on your tracheostomy tube in order to moisturize the air that you will be “breathing”. Because the air you breathe will not be “warmed up” or moisturized by the normal breathing process, the air you breathe through the tracheostomy will be much drier. The heat and moisture exchanger will use a saline solution to humidify the air that you breathe. Failure to do this will result in the irritation of the tracheostomy, causing excess mucus to build up, and the tracheostomy to be irritated. In the alternative, a humidivent will be attached to the tracheostomy. This serves the same function as the heat and moisture exchanger, but this will simply capture the moisture from the air you exhale to humidify the air you breathe.
If there are any other issues involved with the tracheostomy, your health care team will work with you to answer any questions you may have.
After your surgery, you will not be able to speak. Talk to your physician and ask him to recommend a speech therapist for you. Do not perform any strenuous activity for six weeks after your surgery. You will be able to properly care for your tracheostomy tube, including how to change your dressing, how to clean the hole, and how to clean, replace, and suction the tracheostomy tube, before you ultimately leave the hospital.
The hole around your tube should be pink and painless, but you will normally have a small amount of mucus around the hole and the tube. Keep the tube free of thick mucus, and carry around a spare tube with you in case the tube you’re using gets filled with mucus. Should your current tube get clogged, replace it with your spare tube, and then clean out the old tube and use that one as the backup. Talk with your doctor about the steps you have to take to keep the air you breathe moist, and how to keep your tube unclogged.
Always carry a tissue around with you to catch any expectorant mucus from the tube.
You can keep the air that you breathe moist in a few simple ways:
- Put a wet gauze or cloth outside your tube, and always keep it moist.
- Invest in a humidifier for your home.
- Use saline drops to unclog your tubes should they get clogged, and to cough up excess mucus in your system.
When you go outside, cover your tracheostomy hole with a cloth or a tracheostomy cover. This cloth and/or cover will also work to keep your clothes clean, and to keep you from breathing too heavily.
In order to speak, cover your hole with your finger, or a cap. Sometimes, as well, you will be able to speak by capping the tube. Do not get your tracheostomy hole wet — which means, cover it when you’re in the shower, and don’t go swimming.
Caring For Your Tracheostomy
To prevent infection, clean your tracheostomy hole at least once a day with either a Q-tip or some cotton balls. Do this after the soreness goes away. Change the ribbons (trach ties) that keep your tube in place if they get dirty. Hold the tube in place, and be sure you can fit two fingers underneath the trach ties to make sure it isn’t too tight. Change your gauze dressing, which catches mucus in addition to keeping the tube in place on your neck, at least once a day, or every time it gets dirty.
The board-certified Otolaryngologist/Head and Neck Surgeons of Suncoast ENT Surgical Specialists have the knowledge and expertise you need for your tracheostomy. Please contact our Tampa and Spring Hill office to schedule a personal consultation. If you have received a traumatic injury to your neck and are having trouble breathing, please seek medical attention immediately.