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A tracheotomy is a surgical opening through the neck into the throat. The opening is called a stoma or tracheostomy. It may be temporary or permanent.
A tube called a tracheotomy tube will be inserted into the tracheotomy. Air may pass directly through this tube or tubing will be attached to a machine that assists in breathing.
|Airflow Through a Tracheostomy|
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Reasons for Procedure
A tracheotomy is done to open a new pathway for air to move into the lungs. Breathing is impaired by damage or illness in the upper airways from:
- Smoke or chemical inhalation, or burns
- Nerve or muscle problems that affect the airway or breathing
- Weak chest and diaphragm muscles
- Narrowing of the airway just below the voice box
- Physical defects of the head, neck, or airway
- Foreign body obstruction
A tracheotomy may also be done if long-term mechanical ventilation is needed. A tracheotomy allows for greater movement, the ability to eat and drink by mouth, and the ability to speak while receiving ventilation. It can also prevent aspiration of food and liquids into the lungs.
Problems from the procedure are rare, but all procedures have some risk. Your child’s doctor will review potential problems, like:
- Infection, especially pneumonia
- Air trapped in the chest, lungs, or skin around the tracheostomy tube
- Damage to nearby structures, such as vocal cords, nerves, or esophagus
- Lung injury
- Problems with swallowing, speaking, or eating
- Blockage of the tracheostomy tube
- Abnormal connection to esophagus or other structures—fistula
What to Expect
Prior to Procedure
Your child’s doctor will do the following before the tracheotomy:
- Physical exam
- Blood and urine tests
- Imaging tests to evaluate the airway and surrounding structures
Talk to your child’s doctor about all medications your child uses. Your child may need to stop taking some medications prior to the procedure.
General anesthesia will be used. Your child will be asleep during the procedure.
Description of the Procedure
A cut will be made in the skin of the neck. A section at the front of the windpipe will be removed. A tracheostomy tube will then be fitted into this opening in the windpipe. Depending on the situation, an inflatable cuff may be part of the tube. The cuff is most important when the tube is being used for mechanical ventilation, to keep air going into the lungs and not leaking into the mouth. The skin will be closed with stitches or clips.
How Long Will It Take?
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
The length of stay will depend on the reason for the procedure. Most stays are 1-5 days.
At the Hospital
Right after the procedure, your child will be in a recovery room where their blood pressure, pulse, and breathing will be monitored. Recovery may also include pain or anti-nausea medications.
The tracheostomy tube will be used for breathing as long as it is in place. The hospital staff will make sure the tracheostomy tube is working properly. In some cases, a chest x-ray can be used to evaluate the tracheostomy tube.
During your child’s stay, the hospital staff will take steps to reduce their chance of infection such as:
- Wash their hands
- Wear gloves or masks
- Keep your child’s incisions covered
There are also steps you can take to reduce your child’s chances of infection such as:
- Wash your hands often and reminding visitors and care team to do the same
- Remind your child’s healthcare providers to wear gloves or masks
- Do not allow others to touch your child’s incisions
Tracheostomy tubes need to be cared for on a regular basis. The hospital staff will teach you how to care for your child’s tracheostomy tube. It is important follow the staff’s instructions to prevent infection and airway obstruction. Other specialists will help your child adjust to the tracheotomy and learn how to speak and eat with the tracheostomy.
Tracheostomy tube care considerations include:
- Regular cleaning and replacement of tube
- Regular clearing of secretions
- Keeping the airway open
- How to use oxygen or a humidifier (if needed)
Learning to keep your child away from irritants that affect the airway such as
- Strong odors
- Powders and heavy dust
- Fuzzy blankets, toys, or clothing
- Speaking and eating techniques
- Learning cardiopulmonary resuscitation (CPR)
- Knowing when to call for emergency medical services
Call Your Child's Doctor
Call your child's doctor if any of these occur:
- Signs of infection, including cough, excessive foul-smelling mucous, fever, or chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Pain that cannot be controlled with medications your child was given
- Shortness of breath
- New or unexpected symptoms
Call for emergency medical services right away if:
- Your child’s tracheostomy tube falls out and you cannot replace it
- Your child is having problems breathing through the tube
If you think your child has an emergency, call for emergency medical services right away.
American Pediatric Surgical Association
The Society of Thoracic Surgeons
Caring for Kids—Canadian Paediatric Society
The College of Family Physicians of Canada
About the procedure. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/tracheostomy/about/index.html. Accessed January 11, 2019.
Deutsch ES. Tracheostomy: pediatric considerations. Respir Care. 2010;55(8):1082-1090.
Frequently asked questions (FAQ) about tracheotomy and swallowing. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/slp/clinical/frequently-asked-questions-on-tracheotomy-and-swallowing. Accessed January 11, 2019.
- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 11/2018
- Update Date: 01/08/2019