A tracheostomy is a surgical opening in the trachea (windpipe) which is made through the skin in the neck.
A tracheostomy tube is inserted through this hole to keep it open. This means that when you breathe, air can pass through this tube instead of having to go through the nose or mouth.
A tracheotomy is when you make the hole in the trachea without putting in the tube.
You may need a tracheostomy at Great Ormond Street Hospital (GOSH) if:
- you have a narrow windpipe
- if your airway is obstructed
- to clean or to remove fluid from the lower chest
- if you are needing long-term ventilation
How it's inserted
You will have to discuss your health with the doctor and anaesthetist before the operation and discuss what will happen.
All girls aged 12 years or older are tested to make sure they are not pregnant on the day of their procedure. If they are found to be pregnant the surgical team will decide if the procedure should be delayed or cancelled.
You will be asked to wear a hospital gown and then you will be wheeled to the operating suite. You may have an intravenous line inserted (a drip) and you will have heart and oxygen monitoring equipment attached to you, so that the staff will be able to check that everything is alright during the operation.
You will be given a general anaesthetic and will not be aware of the operation happening. The anaesthetist will stay with you throughout the operation to make sure that you have the right amount of anaesthetic and that your heart rate, blood pressure etc are all OK.
The surgeon will make a small cut (known as an incision) into the skin around your throat and the lower part of your neck. He will then divide the neck muscles and move the thyroid gland out of the way so that he can see the trachea (your wind pipe). He will then insert the tracheostomy tube into this hole.
After the surgery
Cotton tapes will be used to keep the tube in place. If you need oxygen, this can be attached to the tube and if you cannot breathe on your own, your tube will be attached to a ventilator. After the operation you may have some difficulties eating but this will be monitored by the nursing staff caring for you.
Sometimes people have problems swallowing properly after a tracheostomy. It can take a while to get used to but usually it just takes time. If the problem continues you may have to see a speech and language therapist for some help.
You will probably have to see a speech and language therapist anyway for help with your speech. It can be hard to get used to but with practice most people (who are not on ventilators) can talk with tracheostomies.
How long will it take to put in?
The surgery will take around 30 minutes to complete but it will also take time to put you to sleep and then to wake you up, so in total it will take about an hour.
How long will you have it for?
You will have to talk to your doctor about this, some people will only have it for a short time and others may have it permanently. The hole which the surgeon makes grows smaller over time and if you have a tracheostomy for a long time you may need to have surgery to open the hole up properly again.
Does it hurt?
It may hurt a little. You will be asleep during the operation and won’t feel it. Afterwards it may hurt a bit until it has healed. Some young people complain about a mild discomfort around the neck but this is usually relieved with paracetamol.
Tips for caring for your tracheostomy:
- When you have a bath, make sure the water level is well below the tracheostomy as you must not get water in the tube. You can have a shower but be careful not to splash water in the tube. Keep a pump close by just in case.
- Don’t go swimming and be careful when paddling or near water. You may still be able to have hydrotherapy treatments though. You will need to talk to the clinical staff if necessary.
- When choosing clothes don’t pick something that will be too tight around the tracheostomy. Also clothes that are very woolly may shed fibres that may enter the tube – try to avoid these also.
- Pets can also shed fur which can enter the tracheostomy. Pets that live in sawdust floored cages can also cause problems. If you have a pet please discuss this with your doctor.
- Keep away from smokers and aerosols. When you breathe in smoke or fumes they will go straight to your lungs and cause irritation.
Keep a bell by your bed in case you need some help in the night.