A tracheostomy is a surgical procedure that produces an opening, called a stoma, in the neck leading to the trachea. This procedure is performed to bypass an obstruction in the upper airway between the mouth and the lungs, to clean and remove any secretions that might be blocking the airway, or provide a more efficient method of delivering air to the lungs. In this procedure a tube, called a tracheostomy tube, is then inserted into the stoma and directly into the trachea to help keep the airway open for breathing.
Typically, a tracheostomy tube consists of an inner tube and an outer tube — called the inner cannula and outer cannula — along with an obturator. The obturator serves as a guide for the outer tube during insertion. It is then removed after insertion, leaving the outer tube in place to act as a passageway for air to get through. In some cases, a single-cannula tube is used with no inner tube. This method is often used for small children who require this procedure.
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Certain varieties of tubes can be used depending on the nature and severity of the problem afflicting the patient. A cuffed tracheostomy tube is often required to allow for mechanical ventilation in the case of patients with severe respiratory failure. Generally, a tracheostomy tube cuff can be inflated via a variety of methods, and when inflated, the cuff blows up like a small balloon and allows for mechanical ventilation to occur. Fenestrated tracheotomy tubes are valuable in some cases because they allow patients to regain the power of speech thanks to an opening on the tube that brings air in through an upper airway.
There also is a device called a tracheostomy tube holder. Holders can be used to stabilize a tracheostomy tube by securing it via hooks that are attached to the neck flange of the tube. The holders adjust around the neck and are usually made of a soft material, such as cotton, providing comfort for the patient without damaging the skin.
A tracheostomy tube requires maintenance that varies depending on the severity of the problem. There are cases when a patient will improve to the point where a tube is no longer necessary, at which point it is removed, leaving a scar at the area of the original stoma. Most cases do require tubes to be in long-term. The initial tube is usually replaced about two weeks following surgery, and if patients need a tube for a long period of time, they may need to learn how to perform maintenance on the tube themselves. This could include tasks such as suctioning out the trachea or even cleaning and changing the tube.