A tracheostomy is surgery to make a hole in your neck that goes into your windpipe. If you need it for just a short time, it will be closed later. Some people need the hole for the rest of their life.
The hole is needed when your airway is blocked or for some conditions that make it hard for you to breathe. You may need a tracheostomy if you are on a breathing machine (ventilator) for a long time.
After the hole is made, a plastic tube is placed in the hole to keep it open. A ribbon is tied around the neck to keep the tube in place.
The surgery is done in the hospital. Before you leave the hospital you should be able to:
Clean, replace, and suction the tube
Keep the air you breathe moist
Clean the hole with water and mild soap or hydrogen peroxide
Change the dressing around the hole
DO NOT do strenuous activity or hard exercise for 6 weeks after surgery. After your surgery, you may not be able to speak. Ask your doctor for a referral to a speech therapist to help you learn to talk with your tracheostomy. This is usually possible once your condition improves.
You will have a small amount of mucus around the tube. This is normal. The hole in your neck should be pink and painless.
It is important to keep the tube free of thick mucus. You should always carry an extra tube with you in case your tube gets plugged. Once you put in the new tube, clean the old one and keep it with you as your extra tube.
When you cough, have a tissue or cloth ready to catch the mucus coming from your tube.
Your nose will no longer keep the air you breathe moist. Talk with your doctor about how to keep the air you breathe moist and how to prevent plugs in your tube.
Some common ways to keep the air you breathe moist are:
Putting a wet gauze or cloth over the outside of your tube. Keep it moist.
Using a humidifier in your home when the heater is on and the air is dry
A few drops of salt water (saline) will loosen a plug of thick mucus. Put a few drops in your tube and windpipe, then take a deep breath and cough to help bring up the mucus.
Protect the hole in your neck with a cloth or tracheostomy cover when you go outside. These covers can also help keep your clothes clean from mucus and make your breathing sounds quieter.
DO NOT breathe in water, food, powder, or dust. When you take a shower, cover the hole with a tracheostomy cover. You will not be able to go swimming.
To speak, you will need to cover the hole with your finger, a cap, or a speaking valve.
Sometimes you can cap the tube. Then you might be able to speak normally and breathe through your nose and mouth.
Caring for Your Tracheostomy
Once the hole in your neck is not sore from the surgery, clean the hole with a cotton swab or a cotton ball at least once a day to prevent infection.
The bandage (gauze dressing) between your tube and neck helps catch mucus. It also keeps your tube from rubbing on your neck. Change the bandage when it is dirty, at least once a day.
Change the ribbons (trach ties) that keep your tube in place if they get dirty. Make sure you hold the tube in place when you change the ribbon. Be sure you can fit 2 fingers under the ribbon to make sure it is not too tight.
When to Call the Doctor
Call your doctor if you have:
Fever or chills
Redness, swelling, or pain that is getting worse
Bleeding or drainage from the hole
Cough or shortness of breath, even after you suction your tube
Nausea or vomiting
Any new or unusual symptoms
Call your local emergency number if your tracheostomy tube falls out and you cannot replace it.
Morris LL, Afifi MS. Tracheostomies: the complete guide. New York, NY: Springer; 2010:chap 7.
Weinstein GS, Laccourreye O, Rassekh CH, et al. Conservation laryngeal surgery. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology Head and Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 110.
Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.