Tracheostomy and critical care

What is a tracheostomy?

A tracheostomy tube is a small tube inserted into the neck. It sits inside the windpipe providing more direct access to the lungs.

Tracheostomy cross section diagram. Throat parts and tube location for breathing.

The staff who may be involved when you have a tracheostomy includes:

  • Doctors
  • Speech and Language Therapist (SLT)
  • Physiotherapist (PT)
  • Critical Care Outreach
  • Nurses

Why and when is a tracheostomy tube needed?

A tracheostomy tube is inserted to:

  • To help you breathe by allowing a direct route to the lungs
  • To enable suctioning – to help remove secretions (phlegm) from the lungs
  • To stop saliva going into the airway

Why do we need to suction?

Suctioning helps to clear secretions from the lungs and helps to avoid chest infections. You may be too weak to cough up your secretions.

Suctioning can be uncomfortable but it is necessary to help your breathing and keep your chest clear.

Tracheostomy is an opening in the front of the neck.

Why can't I speak?

When the tracheostomy cuff is inflated you will be unable to speak. This is because air cannot pass through the vocal cords. You will be able to mouth words but will be unable to produce voice. You may find it helpful to write things down or use a picture or alphabet board in order to communicate.

Tracheostomy tube in neck

 When your breathing gets easier and when appropriate your cuff will be deflated and a Speech and Language Therapist will assess your voice with a speaking valve. With the valve in place, air will be re-directed through your larynx (voice box) on exhalation enabling you to speak verbally.

What about eating and drinking?

Swallowing can become difficult with a tracheostomy. The SLT will therefore be involved 
to assess your swallow when it is felt you may be ready to start eating and drinking.

Following this the SLT will recommend safe consistencies to eat and drink. You may be placed ‘Nil by Mouth’ if your swallow is unsafe, i.e. food and/or drink are ‘going down the wrong way’, or you may be started on very small amounts of food.

SLT provide advice to you and your family/carers and advise/liaise with other healthcare
professionals.

What is the process for tracheotomy removal?

Every patient is different and weaning from a tracheostomy will vary patient to patient. Decisions are made by the specialist tracheostomy team including Physiotherapist, Speech and Language therapist, Nurses and Doctors.

When can the tracheostomy be removed?

This is depending on a number of factors including:

  • Ability to cough secretions to mouth (no need for suctioning)
  • Able to breath independently
  • The reason for insertion

Tracheostomy Tube Photo credit: Klaus D. Peter, Wiehl, Germany has published this file under a “Creative Commons License”, CC BY 3.0 DE, via Wikimedia Commons

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