Tracheotomy

WHAT YOU SHOULD KNOW:

Tracheotomy (Inpatient Care) Care Guide

  • A tracheotomy is a surgery done to help you breathe through an opening in your trachea. The trachea is the tube that runs down inside the front part of your neck. The air you breathe passes from your nose or mouth, down your trachea, and into your lungs. The lungs then deliver the oxygen taken from the air to your blood and body organs. You may need this surgery if you are very sick and need long-term help with your breathing. You may need this surgery if you have a disease that damages the muscles used in breathing. You may also need a tracheotomy if you cannot clear the mucous out of your airways. This surgery may also be done if you need emergency breathing help from an injury.

  • With a tracheotomy, a cut or a small hole is made in your neck and trachea. A plastic or metal tube, also called a trach, is put into the incision or hole. This tube may be connected to a breathing machine to help draw air into your lungs. The tracheotomy may also be used to suction out phlegm that may be blocking your airways. Having a tracheotomy may decrease your breathing problems and improve the oxygen levels in your body.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During your surgery, you may have too much bleeding and your vital signs may be unstable. You may get an infection in the area of the cut. Air may get trapped under your skin through the opening in your neck. You may have trouble breathing if the tube in your trachea is blocked by blood clots or phlegm. The trach tube may come out on its own, making it hard for you to breathe. Caregivers will watch you closely for early signs of these problems.

  • You may get a lung infection or have trouble swallowing after surgery. Your trachea may narrow and decrease the amount of air getting into your lungs. The tube in your neck may also rub on your trachea or the blood vessels in your neck. This could make an abnormal hole that bleeds or allows food and fluid to get into your lungs. Your body may react to the trach tube by forming tissue lumps around or near the opening. If you do not have the surgery, you may continue to have increased trouble breathing. Body organs, such as your heart and brain may not function well from a lack of oxygen. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Medicines: You may receive any of the following medicines before your tracheotomy:

    • Antibiotic: You may be given an antibiotic medicine to prevent an infection.

    • Conscious sedation: This is medicine that will make you relaxed and sleepy. This medicine will help keep you from getting restless or having discomfort during your surgery.

    • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. The medicine will cause you to be completely asleep and free from pain during surgery.

    • Local anesthesia: This is a medicine that may be used to numb your neck before your surgery.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During your surgery:

A small incision will be made in front of your neck, and another in your trachea. Your caregiver will make sure that your thyroid gland, neck muscles, and blood vessels are not damaged. Your caregiver may also use a needle to put a small hole into the trachea instead of an incision. He will then place a guidewire into your trachea and widen the hole using special tools. He may use a bronchoscope which is a tube with a light and tiny camera on the end. This will take pictures of the inside of your airways that can be seen on a TV-like screen. A metal or plastic tube will then be inserted into the cut or hole in your neck.

After your surgery:

The tracheotomy tube may be connected to a breathing machine to help you breathe. Caregivers will suction out any phlegm, and continue to monitor your vital signs. Caregivers will do trach care to keep your new tracheotomy area clean and dry. Your trach tube has an inflated cuff that helps decrease any air leaks and keep it secure. Your caregiver may check the cuff pressure often to ensure it is not so full that it harms your trachea. Do not get out of bed until your caregiver says it is OK. You may be asked to sit in a chair after you are fully awake. Any activity after your surgery will be for short time periods and increase as you become stronger.

Blood gases:

This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.

Chest x-ray:

This is a picture of your lungs and heart. Your caregivers may use this to look for any lung problems after your surgery.

Deep breathing and suction:

Deep breathing may help prevent a lung infection. Deep breathing opens the airway tubes going to your lungs. Caregivers will help remove any mucus if you are having trouble getting it out of the tube. This is done by putting a plastic suction tube down into your trach tube to get the mucus out.

Eating:

You may be fed liquid nutrition through a plastic tube put into your nose or mouth. The liquid nutrition will give you all the vitamins, minerals, and protein you need to help you heal. You may also be able to eat by mouth starting with blended foods. To decrease the risk of the liquid or food getting into your trachea, your head should be raised. Your caregivers will work with you to make sure no problems occur.

Fears and concerns:

It is normal to be afraid of choking or not being able to talk with a trach tube. You may also be worried about getting the saliva or mucus out of your throat. Tell your caregivers about your fears and concerns so they can help you.

Mouth care:

Your caregivers may use special swabs to keep your mouth clean and moist after your surgery.

Oxygen:

You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your trach tube. It may also be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen.

Talking:

You will not be able to talk with the tube in your throat for many days after your surgery. Your caregiver will help you learn how to let others know what you need. When you are able to talk, air will be released from the cuff around your trach. You may need to cover the trach tube with a finger while exhaling (breathing out). This will let air pass into your voice box allowing you to talk in a whisper. A special one-way valve may also be used to help you talk.

Ventilator:

This is a machine to help you breathe after having your tracheotomy tube put in. The machine is connected to your tube by a large plastic tube. Oxygen flows through the plastic tube and into your lungs. The ventilator will be unhooked from your tube once you are breathing on your own. You may still need oxygen even if you are breathing on your own.

Wound and tube care:

Your caregiver will make sure that the hole in your neck is clean and dry to prevent infection. Your trach tube will have and inner and outer cannula (tube). The inner cannula may need to be changed daily. This will also help to decrease your risk of infection.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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