Health A to Z
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 remove any fluid that's built up in the throat and windpipe.
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A tracheostomy may be carried out to:
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.
Read more about why a tracheostomy may be needed.
A planned tracheostomy is usually carried out under general anaesthetic, which means you'll be unconscious 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.
A dressing will be placed around the opening in your neck and tape or stitches will be used to hold the tube in place.
If you're unable to breathe unaided, the tracheostomy tube can be attached to a machine that supplies oxygen to assist with breathing (ventilator) to increase the flow of oxygen to your lungs.
Specialist equipment can also be used to warm and moisten (humidify) the air breathed in.
In an emergency, the tracheostomy will be carried out as soon as possible using a local anaesthetic if there isn't enough time to use a general anaesthetic.
This means you'll be conscious during the procedure, but shouldn't feel severe pain.
After having a tracheostomy, 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 you leave hospital.
However, the tube may need to stay in permanently if you have a long-term condition that affects your breathing.
It's possible to enjoy a good quality of life with a permanent tracheostomy tube, but it can take some time to adapt.
Most people will initially have difficulty talking, eating, exercising, and keeping the tracheostomy tube clean and free of blockages.
If you need a tracheostomy, a specially trained therapist can give you advice and answer any questions you have.
They'll make sure you feel confident about looking after the tracheostomy before you leave hospital.
Read more about living with a tracheostomy.
A tracheostomy is generally a safe procedure that works well. But, as with all medical procedures, there's a small risk of complications, including bleeding, infection, and breathing difficulties.
Read more about the possible complications of a tracheostomy.
A tracheostomy is sometimes needed if you're unable to breathe normally because of an underlying health condition or a blocked airway.
A tracheostomy can deliver oxygen to the lungs if you can't breathe normally. This is known as respiratory failure.
Conditions that can lead to respiratory failure and the need for a tracheostomy include:
In some cases, a tube attached to an artificial breathing machine (ventilator) is inserted into the mouth and down the throat.
But this can be uncomfortable, so a tracheostomy may be carried out if you need help breathing for more than a few days.
A tracheostomy can also be used to bypass an airway that's become blocked as a result of:
In addition, some children born with birth defects that cause their airways to be abnormally narrow may need a tracheostomy to help them breathe.
It may be necessary to carry out a tracheostomy to remove fluid that's built up in the airways.
This may be needed if you:
It's possible to enjoy a good quality of life with a permanent tracheostomy tube.
However, some people may find it takes time to adapt to swallowing and communicating.
Your care team will talk to you about possible problems, the help that's available, and how 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 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.
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 by taking small sips of water before gradually moving on to soft foods, followed by regular food.
If you have swallowing difficulties, a speech and language therapist can teach you some techniques that may help.
After having a tracheostomy you should be able to continue doing everyday activities, but should avoid vigorous activities for about six weeks after the procedure.
It's very important to keep your tracheostomy opening clean and dry when you're outside. The opening will usually be covered with a dressing.
You could also wear a loose piece of clothing, such as a scarf, to stop substances such as water, sand or dust entering the opening and causing breathing problems.
A tracheostomy tube needs to be cleaned regularly to stop it becoming blocked with fluid and mucus. 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.
A tracheostomy is usually safe and straightforward but, as with many medical procedures, it does carry a risk of complications.
The likelihood of complications will depend on:
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.
This is usually minor and improves 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 them 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 tube that runs from the back of the throat to the stomach (oesophagus). This may cause problems with speaking and swallowing.
The windpipe or nearby tissues can become infected. If this happens, treatment is usually with antibiotics.
Some of the complications that can occur days, weeks or even months after a tracheostomy are described below.
Sometimes the tracheostomy wound doesn't 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.
There is a risk that the tracheostomy tube could become suddenly or gradually blocked with mucus and fluids if you're unable to clear your airways by coughing.
This risk can be reduced by ensuring the tube is cleaned regularly and any fluid is suctioned out.
Sometimes the windpipe collapses in on itself because its walls aren't strong enough to support it. This usually occurs when the tracheostomy tube hasn't been fitted properly. Treatment involves 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.