When is a tracheostomy needed?

To begin with, let us elucidate a bit on what tracheostomy is. The procedure that involves an opening made in the neck for direct access into the trachea or windpipe is known as a tracheostomy. Several conditions might require a tracheostomy and this requirement could be either short-lived or for the rest of the patient's life!

Conditions that essentially need a tracheostomy are –

• Mouth and throat cancers where breathing and even swallowing becomes a difficulty

• Reconstruction of airways after laryngeal and tracheal surgery

• Swallowing difficulty due to edema and/or other injuries in the throat and neck region

• Head and neck surgery

• Dependence on ventilators for long periods

• Air passage defects that are inherent

• Burning of the airways due to inhalation of corrosive material

What are the main components of a tracheostomy set up?

A tracheostomy tube commonly consists of 2 main parts – the outer cannula along with the flange, and the inner cannula. The latter, in some cases, is optional. The opening in your neck is called the stoma. The flange or the neck-plate sits on the stoma. The tube that is inserted in this stoma is indeed secured with the help of trach tube ties that are fastened to holes on either side of the neckplate.

The outer cannula may be fitted with an inner cannula that lies within. It has a lock to keep it in place and is removable for washing and cleaning purposes. Trach tubes are available in the ‘cuffed’ variant too. These are needed by patients who have swallowing difficulties.

How long does it take to adapt to the tracheostomy tube?

Immediately after tracheostomy, you will not be able to talk. This is a major challenge. Permanent procedures are, therefore, life-changing.

Initially, it takes almost 3 days to adapt to breathing through trach tubes. Talking and making sounds need a lot of practice too. You cannot produce sound normally anymore. This is because the air that you breathe does not pass through the voice box. Many patients, therefore, cover the tube to help themselves to talk!

How to care for my trach tubes?

Trach care involves cleaning as well as suctioning parts of the tracheostomy appliance that you are wearing. You need to start with a pair of sterile gloves on. The very first step is suctioning the trach tube. In case there's an inner cannula it should be removed, held over a washbasin, and rinsed with hydrogen peroxide. It should be cleaned thoroughly using pipe cleaners or even a small brush. This needs to be followed with a tap-water wash (distilled or saline water would be safer). The inner cannula also needs to be thoroughly dried inside out (using a mesh gauze pad). Re-insert it and lock it in place.

What self-care measures need to be taken following a tracheostomy?

Tracheostomy involves wearing an artificial device 24x7 around your neck. So, the skin obviously needs some extra care. Especially the skin around the stoma needs attention. A gauze pad soaked in a 1:1 ratio of hydrogen peroxide and sterile water should be used to gently wipe the skin surrounding the stoma. Some amount of mucus often dries down under the flanges. Clean them using cotton. After cleaning, the area needs to be patted dry and applied with an antibacterial ointment, if necessary. Don’t forget to clean the flanges or change wet and dirty trach ties.

Preventing infection is a major challenge for tracheostomy patients. Apart from cleaning the appliance and its parts, a few important things need to be considered. Keep your mouth extra cleaning by brushing and using mouthwashes twice daily (as saliva and mucus contain germs).

You can also try this – Take deep breaths. After letting the air out, cough strongly. This is to be repeated 10 times each hour! It clears congestions and keeps infections away.