Tracheostomy

An overview

• The trachea is a tube that carries air from the larynx (voice box) to the lungs, it is commonly known as the windpipe.
• A tracheostomy is an opening made in the trachea for breathing.
• A tracheostomy is usually done at the same time as surgery for cancer, and is a temporary measure to help recover from surgery. In some types of cancer, it is done as a permanent procedure.
• A tracheostomy tube is a special tube that is inserted into the opening. The tube may be held in place by sutures, cotton tapes or velcro bands. The tube has two parts:​
  • An outer tube (cannula): this makes contact with the tissue and usually stays in place. It may have a balloon (cuff) that can be inflated with a syringe to create a seal
  • An inner tube (cannula): this can be taken in and out to be cleaned. It may have a special hole (fenestration) to help you talk when the tracheostomy is in.
• Instead of having air going through the mouth and nose when breathing, a tracheostomy allows air to go in and out through the tube instead.

Side effects and their management

As with all operations, there is a chance that tracheostomy may lead to a number of side effects. You may not experience all of the side effects. Speak with your doctor if you have any questions or concerns about treatment side effects.

Side effects common for tracheostomy may include:

• Prolonged healing of the wound once the tube is removed, with ongoing leakage of air
• There may be some irritation, coughing and secretions when the tube is first inserted. These usually settle down as your windpipe gets used to the tube
• Scarring of the skin where the tube was inserted.
• A change in your voice.

Pain Management

Pain is a common side effect of the operation. Your anaesthetist will give you pain medicine during the operation to keep you comfortable when you wake up, and you may continue on pain medicines to ensure pain is under control. Ensure you take pain relief medications as prescribed by your doctor and speak to your cancer care team if the pain is not under control, gets worse or if the medication causes any side effects.

Before going home

• The tracheostomy tube is usually removed before leaving the hospital. However, if you have to go home with the tracheostomy tube, it is very important that you know how to look after it. You will be given information and careful instructions in hospital, and you will not be discharged until you and your carers are completely comfortable with looking after your tracheostomy tube.
• It is very important to keep the breathing tube clean. It can be very dangerous if the airway becomes blocked. Using a small mirror can aid you with caring for the tube.
• Ask as many questions as you need to while you are still in hospital. To get more confidence, practice looking after the tube as much as you can. It can feel daunting but is quite simple. Don’t worry and be sure to ask any questions you have.
• It helps if someone else that you live with or see regularly, also learns what you have to do too.
• Your doctor will advise you about any particular symptoms you should look out for such as pain and redness around the tube site, bleeding from the tube, difficulty breathing or swallowing, or fever, and what you should do.
• Any particular instructions for wound care or medications will be provided to you before you go home. 
• You will be assessed by the team involved in your care before you go home and follow-up arranged with your surgeon and GP. 
• Follow-up will also be arranged with a speech pathologist and dietitian to help you with speaking, swallowing and eating, and with any other allied health professionals to assist you with supportive care.

Follow-Up care

• After your operation, you will continue to have regular follow-up visits with your specialist doctor and cancer care team.
• You will have follow-up with the speech pathologist to help you with speaking. A dietitian may also assist with swallowing or eating difficulties.
• Other referrals will be arranged as needed with other health professionals to assist you with any other difficulties or supportive care.
• Any additional reconstruction, cosmetic procedures or treatments that you may need are planned after discharge. This enables time for you to recover from the initial operation, get results of the pathology that examined the tissue removed at the operation, and make the arrangements for any additional treatment or next steps.

Questions to ask your doctor

• Is my tracheostomy temporary or permanent?
• If temporary, how long will my tracheostomy tube be in for?
• How would you recommend I communicate whilst my tracheostomy is in place?
• How long will the operation take?
• How long will I be in hospital?
• What are the possible side effects of tracheostomy? How can they be prevented or managed?
• Will I need any extra treatment?
• What lifestyle changes (diet, exercise) do you recommend that I make?
• How much will the operation cost? Will my health insurance cover it?
• Will I be able to lead a normal life?
• What follow-up tests will I need after the operation?