Tracheostomy

What is a tracheostomy?

A tracheostomy is a surgical procedure that creates an opening in your child's neck and windpipe (trachea). A tube is then placed in the opening to keep it open. The procedure helps get air to your child's lungs.

The term tracheostomy may be used to refer both to the procedure and to the opening created by the procedure.

When is it used?

A tracheostomy may be done when your child has a problem with the airway. If the upper airway is blocked, a tracheostomy can bypass the blockage to provide airflow to the lungs. It is also used to provide oxygen to the lungs more efficiently and to clear secretions from the airway.

Examples of when your child might need a tracheostomy include:

• the upper airway is blocked by swelling, a tumor, vocal cord problems, or a severe narrowing of the trachea.
• your child will be on a breathing machine (ventilator) for a long time.
• your child has had a traumatic injury and needs the airway to be protected.
• your child has lots of secretions or too much saliva that he cannot get rid of and so he needs frequent suctioning of the airway.

What happens during the procedure?

A tracheostomy is usually done in an operating room or in an intensive care unit. Your child's heart and oxygen levels are monitored during the procedure.

First your child is given an anesthetic. The anesthetic should keep your child from feeling pain during the procedure. Then the surgeon makes a cut (incision) in the neck and trachea in the area of the neck below the Adam's apple and voice box (larynx). A tube is placed in the opening. The tube is held in place with a band or laces around the neck.

What happens after the procedure?

The tracheostomy site will begin to heal and the surgeon will monitor your child for a few days. The original tube is usually kept in place for 5 to 10 days. After that a new tube may be used.

If your child is on a ventilator, the tube will have a balloon around it that prevents air from leaking. In this case your child will not be able to talk. If no ventilator is needed, a smaller tube may be used that allows air to pass around it. In this case your child may be able to talk.

When the tracheostomy is no longer needed, the surgeon will remove the tube and close the opening in the neck.

How is a tracheostomy cared for?

If your child still has the tracheostomy when he goes home from the hospital, your health care provider will teach you or your family how to care for the tracheostomy. This will include cleaning the tracheostomy site, suctioning, and changing the tube.

What are the complications?

Possible complications of a tracheostomy are:

• bleeding
• infection
• damage to the larynx
• trouble swallowing
• scarring.