Tracheostomy - How a tracheostomy is performed
- Introduction
- Why a tracheostomy is necessary
- How a tracheostomy is performed
- Living with a tracheostomy
- Complications of a tracheostomy
A tracheostomy may be carried out as either an emergency or planned procedure.
Planned tracheostomy
Many tracheostomies are performed on people 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
Both procedures are described below.
Percutaneous tracheostomy
A percutaneous tracheostomy is usually carried out under general anaesthetic in an intensive care unit.
The intensive care specialist will make a small cut in the throat (about 1.5cm to 2cm long) and use a surgical instrument called a dilator to open a hole in the tissues and trachea. The tracheostomy tube is inserted through the incision and guided into place using a guidewire.
Open tracheostomy
An open tracheostomy is usually carried out in an operating theatre under a general anaesthetic. This means you are asleep during the procedure and will not feel any pain.
The surgeon will make a cut in the lower part of your neck, in between your Adam's apple and the top of your breastbone. The muscles are parted and the thyroid gland is cut or moved so that the surgeon has a clear view of your windpipe. They will then make an incision in the wall of your windpipe so that the tracheostomy tube can be inserted through the opening.
After the procedure
After both procedures, an X-ray may be taken to check that 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 to increase the flow of oxygen to your lungs.
After 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.
Percutaneous versus open tracheostomy
An open tracheostomy will be carried out when it is not safe or feasible to perform a percutaneous tracheostomy.
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
- if there is an infection inside the neck or surrounding tissue
Emergency tracheostomy
An emergency tracheostomy may be needed if a person's airway suddenly or unexpectedly becomes blocked following an accident or injury.
It may also be required if someone has 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 and shouldn't feel severe pain.
Trained healthcare professionals, such as paramedics, are able to perform an emergency tracheostomy very quickly. 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 connected to a ventilator (a machine that supplies oxygen to assist with breathing).
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