What is a tracheostomy?
A tracheostomy is a hole that is made in the front of the neck into the windpipe. A tracheostomy tube is then inserted through the hole. Once in place you will be able to breathe on your own or be attached to a breathing machine to help you breathe while you gradually recover from your illness and undergo rehabilitation.
Reasons for having a Tracheostomy tube?
• Airway access
• Support ventilation
• Blockage of the upper airway.
• A tube in the mouth can cause physical damage to the delicate structures through which it passes, including the voice box (larynx), leading to problems later with speaking. A tracheostomy tube is inserted below the voice box and this is potentially less damaging.
• You or your nurse looking after you will be able to clean your mouth properly, reducing the risk of infections.
• Nursing staff, relatives and carers may be able to understand you better by initially lip reading and then hopefully we will begin to help restore your voice.
• A tracheostomy tube may enable you to progress towards eating and drinking sooner. • Secretions in the chest can block the flow of air and cause chest infections. These can be removed by suction through the tracheostomy tube.
There are some risks to having a tracheostomy both during and after the procedure, however every effort will be made to minimise the risk of these complications occurring.
Most tracheostomies can be performed in the Critical Care Unit by the intensive care doctor. Occasionally they may be carried out in the operating theatre and in this instance will be performed by the ENT surgeons.
This will happen if we think the shape of the neck will make the procedure particularly difficult, or if the patient is at high risk of bleeding. We may also go to theatre if we think the tracheostomy will be permanent or if you are requiring an additional procedure.
During the procedure you will be under a general anaesthetic. Local anaesthetic is also inserted into the area at the front of the neck and windpipe to make it numb and painless. After the operation as the anaesthetic wears off, there may be some mild discomfort and soreness in the throat, additional painkillers will be given as required. Increased coughing episodes due to slight movements of the tube is also quite common.
You can temporarily lose your voice while you have a tracheostomy in place.
Some tracheostomies prevent air from reaching the vocal cords. This is due to a balloon (or “cuff”) that is inflated around the tracheostomy tube to help ventilate the lungs more effectively. As air is needed to produce sound in the throat, you will not be able to speak while the “cuff” remains inflated.
Sometimes this may feel frustrating and even distressing. Your rehabilitation team will aid you as best they can with your communication. A speech and language therapist (SLT) may also visit you on critical care to help you with certain communication strategies.
What you can try:
• Try to write down what you want to say if you can.
• Body language such as gesturing and pointing, and facial expressions can help to express yourself.
• Picture boards, pain boards and boards with alphabets can be used and tailored to daily tasks.
• Digital Devices: You can try typing out your concerns and needs on your mobile phone, tablet or laptop computer.
• Behind your bed in ICU, the team has put together a “Getting to Know Me” board and this can help to communicate information about your preferences, likes and dislikes, or things you would like the team looking after you to know.
• Have family members, your carers and friends ask simple yes or no questions.
Communication will improve over time as you get stronger and develop your own strategies.
As your breathing improves, we will gradually help you regain your voice by deflating the tracheostomy “cuff” to help leak air past your voice box. Occasionally, the tracheostomy may be changed to a smaller one to make this easier.
One-Way Valves
Depending on how well you are, another solution is to fit your tracheostomy tube with a One-Way Valve, which is an attachment that allows air to pass through the vocal cords for speech.
A tracheostomy can interfere with your swallowing. You will be assessed by a speech and language therapist who will assess the safety of your swallow and advise on the type and volume of foods and drinks that you can safely have.
You may also be asked to do specific exercises to help improve the strength and safety of your swallow to help progress with eating and drinking. You will likely require a naso-gastric tube (NG) or similar feeding route to ensure you receive adequate nutrition, hydration and medications to optimise your recovery.
Good oral care is essential to keep your mouth and airway clean.
Most patients will need a tracheostomy until they are over their illness and strong enough to breathe without the aid of the ventilator. In rare cases the tracheostomy is needed permanently, especially if the patient has a disease or disorder of the nervous system or muscles. Arrangements would be made in that instance for home care of the tracheostomy.
Post tracheostomy removal (“decannulation”)
When the tracheostomy tube is removed, the hole in your neck will begin to close immediately and should only take 7-10 days to fully heal.
• A dressing will be applied and should be worn to prevent any air leak and therefore help speed healing while absorbing any secretions from the wound.
• You will be advised to provide support to the wound by placing 2 fingers on top of the dressing when talking or coughing to prevent air leaking. If you can’t do this for yourself then a nurse/ carer can assist.
• You may experience pain or discomfort in the area where the tracheostomy tube was. If required, the doctors can prescribe painkillers as appropriate to help with this.
• Talking: Voice changes are common following a tracheostomy however if your voice suddenly becomes more hoarse, weak or whispery then we may arrange for further ENT or Speech and language therapy help.
• Eating and drinking: If you were able to eat and drink normally prior to de-cannulation then oral intake should continue as normal. If there are any concerns regarding swallow ability after de-cannulation, this should be raised with the ward nurse prior to discharge who should refer you back to the Speech and Language Therapy (SLT) team for assessment. If you are fed through a tube in the nose or stomach this may need to continue for the long term however you may continue under the care of Speech and Language Therapy.
If you, your family or carers have ANY questions or concerns regarding your tracheostomy care then please do not hesitate to ask one of your health care professionals.
