When a tracheostomy is planned, patients should follow their physician’s guidelines concerning restrictions in diet or intake of medications. A tracheostomy is an inpatient procedure, so patients should make the appropriate arrangements to inform their work or others that they will be unavailable for at least a few days. However, most tracheostomies are performed while the patient is already hospitalized or as an emergency.

General anesthesia is administered prior to a tracheostomy, which means that the patient will not be awake during the procedure. The neck is cleaned and draped with sterile towels before surgery. During the procedure the surgeon makes incisions through the skin to expose the rigid cartilage rings that compose the outer wall of the trachea. The surgeon then makes additional incisions in a pair of these rings and inserts the tracheostomy tube into the trachea. The size and type of the tubing used in the procedure will depend on a number of factors, including the size of the patient’s trachea. Children have pediatric tracheostomy tubes inserted to accommodate their small size.

Following surgery, patients may be unable to eat or drink or may be able to tolerate only certain foods for a few days because they may experience certain swallowing difficulties. To supplement their nutrition, patients may receive nourishment intravenously or through a feeding tube. This is a thin, flexible tube placed through the nose and into the stomach. It allows liquid nutrition and medications to be provided directly into the stomach. Patients usually will remain in the hospital for three to five days after the procedure. Full recovery from the procedure can take several weeks.  

After a tracheostomy, the hole or stoma remains open. Breathing is performed through the tracheostomy tube in the stoma with direct exchange of the air from the outside into the lungs. Initially, patients may find it difficult to adapt to breathing through the tube. The air is no longer warmed or filtered by the nose or mouth. This discomfort usually passes within a few days. Secretions from the lungs may collect and require more frequent coughing, clearing or suctioning to clear the area.

It is also common for patients to experience difficulty in communicating initially. Air during breathing no longer passes up the trachea and through the vocal cords. The result is the inability to produce speech. During this transition, patients may need to communicate using pen and paper or computer keyboard. A speech pathologist may work with the patient to reduce the swallowing and speech difficulties that can occur following a tracheostomy. Patients will be taught to use certain techniques to improve speech production, such as taking a deep breath and covering the stoma with their finger. With training and practice, most patients learn to eventually adjust to speaking with a tracheostomy.

Following a tracheostomy, air reaching the lungs will be dryer and cooler. The stoma is also open to the environment, creating a risk of dust and debris entering the trachea. Proper care of the stoma is necessary to keep thick or crusty mucus from accumulating in the lining of the breathing tubes and to prevent debris from entering the stoma. Detailed instructions in tracheostomy care are typically provided prior to the patient’s discharge from the hospital. The patient will be given opportunities to clean, change and care for the tracheostomy under medical supervision before leaving the medical facility. Some general recommendations to help with coping with a tracheostomy include:

• Keep the area around the neck and stoma opening clean and free from debris.
  
  
• Keep air moist by using a humidifier or using pans of water near radiators or heaters. In addition, patients may benefit from closing the bathroom door and turning the hot water on to fill the room with steam. Sitting in the room and breathing deeply for 10 to 15 minutes can help moisten the tube and trachea.
  
  
• Keep the tracheal opening free from water while bathing or swimming.
  
  
• Cover the opening with a scarf or shirt made of a breathable material such as cotton that allows air to get through but prevents particles and other debris (aerosols, powders, etc.) from entering the stoma. Or, use a stoma cover, which is made of lightweight, lint-free, washable material and available in many stores that provide medical equipment.

Patients who have a tracheostomy have very few restrictions on activities, although they may be advised to avoid vigorous exercise for six weeks. They should also keep a spare inner cannula tube available in case the inserted tube becomes damaged or needs to be replaced. Individuals will be provided with instructions in how to clean and change the tube during their hospitalization.