What you can expect

During the procedure

A tracheotomy is most commonly performed in an operating room with general anesthesia, which makes you unaware of the surgical procedure. A local anesthetic to numb the neck and throat is used if the surgeon is worried about the airway being compromised from general anesthesia or if the procedure is being done in a hospital room rather than an operating room.

The type of procedure you undergo depends on why you need a tracheostomy and whether the procedure was planned. There are essentially two options:

• Surgical tracheotomy can be performed in an operating room or in a hospital room. The surgeon usually makes a horizontal incision through the skin at the lower part of the front of your neck. The surrounding muscles are carefully pulled back and a small portion of the thyroid gland is cut, exposing the windpipe (trachea). At a specific spot on your windpipe near the base of your neck, the surgeon creates a tracheostomy hole.
• Minimally invasive tracheotomy (percutaneous tracheotomy) is typically performed in a hospital room. The doctor makes a small incision near the base of the front of the neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. Using this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole, then expands it to the appropriate size for the tube.

For both procedures, the surgeon inserts a tracheostomy tube into the hole. A neck strap attached to the face plate of the tube keeps it from slipping out of the hole, and temporary sutures can be used to secure the faceplate to the skin of your neck.

After the procedure

You'll likely spend several days in the hospital as your body heals. During that time, you'll learn skills necessary for maintaining and coping with your tracheostomy:

• Caring for your tracheostomy tube. A nurse will teach you how to clean and change your tracheostomy tube to help prevent infection and reduce the risk of complications. You'll continue to do this as long as you have a tracheostomy.
• Speaking. Generally, a tracheostomy prevents speaking because exhaled air goes out the tracheostomy opening rather than up through your voice box. But there are devices and techniques for redirecting airflow enough to produce speech. Depending on the type of tube, width of your trachea and condition of your voice box, you may be able to speak with the tube in place. If necessary, a speech therapist or a nurse trained in tracheostomy care can suggest options for communicating and help you learn to use your voice again.
• Eating. While you're healing, swallowing will be difficult. You'll receive nutrients through an intravenous (IV) line inserted into a vein in your body, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. When you're ready to eat again, you may need to work with a speech therapist, who can help you regain the muscle strength and coordination needed for swallowing.
• Coping with dry air. The air you breathe will be much drier because it no longer passes through your moist nose and throat before reaching your lungs. This can cause irritation, coughing and excess mucus coming out of the tracheostomy. Putting small amounts of saline directly into the tracheostomy tube, as directed, may help loosen secretions. Or a saline nebulizer treatment may help. A device called a heat and moisture exchanger captures moisture from the air you exhale and humidifies the air you inhale. A humidifier or vaporizer adds moisture to the air in a room.
• Managing other effects. Your health care team will show you ways to care for other common effects related to having a tracheostomy. For example, you may learn to use a suction machine to help you clear secretions from your throat or airway.