Tracheostomy: Overview, Preparation, Procedure, Recovery, Risks, and Aftercare
Overview
During a tracheostomy, a hole (stoma) is created in the neck and a tube is inserted into the windpipe (trachea) as an alternative airway. If the patient requires long-term mechanical ventilation, has an obstruction in the upper airways, or needs assistance clearing secretions, this procedure may be performed.
Preparation
Patients and their healthcare team should do the following before undergoing a tracheostomy:
-
To determine the need for a tracheostomy, patients undergo a thorough medical evaluation, including imaging studies and respiratory function tests.
-
After receiving detailed information about the risks, benefits, and alternatives, patients or their legal guardians provide informed consent for the procedure.
-
To reduce the risk of aspiration, patients may need to fast prior to surgery. They may also receive instructions regarding medication management and hygiene habits.
-
During and after the procedure, the surgical team prepares the necessary equipment and makes sure that respiratory support devices, suctioning equipment, and emergency supplies are available.
Procedure
The following steps are typically performed during a tracheostomy procedure:
-
To ensure comfort during the procedure, patients are given either general anesthesia or local anesthesia with sedation.
-
An incision is made just above the sternal notch or between the first and second tracheal rings in the lower part of the neck.
-
Stoma Creation: A surgeon carefully dissects through soft tissues and muscles to expose the trachea. A portion of the tracheal wall is removed to create the stoma.
-
A tracheostomy tube is inserted into the stoma and secured with sutures or a securing device. It may have an inflatable cuff to prevent air leakage.
-
Visual inspection, auscultation, and capnography are used to verify the correct placement of the tracheostomy tube.
Recovery
Tracheostomy patients may experience the following symptoms after the procedure:
-
Postoperative Care: Patients are closely monitored for respiratory function, vital signs, and potential complications, such as bleeding or airway obstruction, in the recovery room or intensive care unit (ICU).
-
The tracheostomy tube provides ongoing ventilator support to patients requiring mechanical ventilation.
-
Tracheostomy wounds are regularly inspected for signs of infection, and wound care techniques are implemented to promote healing and prevent complications.
Risks
There are certain risks and potential complications associated with tracheostomy, including:
-
Excessive bleeding may occur during or after the procedure, requiring immediate intervention to control the bleeding.
-
Tracheostomy sites may become infected, leading to local inflammation, cellulitis, or deep tissue infections that require antibiotic treatment.
-
A malpositioned tracheostomy tube, accidental decannulation, or the formation of granulation tissue around the stoma may compromise the airway.
Aftercare
Following a tracheostomy procedure, patients and caregivers should follow these aftercare guidelines:
-
Ensure that the tracheostomy site, respiratory status, and tube function are monitored regularly, and that any signs of infection, bleeding, or respiratory distress are reported to the healthcare provider immediately.
-
Follow proper hygiene practices around the tracheostomy site, including cleaning the skin around the stoma with mild soap and water, changing the tracheostomy dressing as needed, and taking care of the tracheostomy tube.
-
Exercises and coughing techniques can facilitate airway clearance and prevent complications such as mucus plugging.
It is possible to optimize recovery and minimize complications associated with tracheostomy surgery by understanding the procedure, preparing appropriately, and following recommended aftercare guidelines.
