A percutaneous tracheostomy is a procedure doctors perform when someone needs long-term airway support. During the procedure, surgeons insert a breathing tube into your neck.
A percutaneous tracheostomy (PT) is a surgical procedure where doctors place a tube in the neck that helps you breathe with a ventilator. A tracheostomy is more comfortable than intubation, which blocks your mouth and throat. Surgeons are able to perform this procedure in your hospital room using local anesthetic and conscious sedation.
Surgeons will make a small incision into the neck. They use a needle to puncture a hole in the trachea between the first and second or second and third tracheal rings (the notches you feel when you press on your throat). Then they place and secure the breathing tube.
The primary purpose of PT is to provide a safe and reliable airway for patients who require mechanical ventilation for longer than 7 days. It’s frequently performed in the intensive care unit (ICU), mostly on people who are intubated and sedated.
It can be performed quickly, making it ideal for people in critical condition who require rapid airway access. It’s also less disruptive than transferring someone to an operating room.
Compared with intubation, PT allows for more accessible access to the trachea for suctioning and management. PT may also help reduce the risk of infection associated with long-term intubation.
PT can be performed on adults and children who have conditions
- stroke
- head and neck cancer
- head injury
- COVID-19
- certain congenital disorders
- vocal cord paralysis
- neurological diseases, such as multiple sclerosis or ALS
- swelling or other airway obstructions
- sleep apnea
PT can be performed anywhere, but it’s most commonly used in the ICU. It’s typically performed by a surgeon and several other specialists, such as respiratory therapists. These healthcare professionals will require specialty equipment and surgical tools, so you may see them setting up before the procedure begins.
Here’s what to expect during a typical procedure:
- The person will remain intubated until doctors are ready to make the switch. Doctors may provide further sedation and pain medication. And may give a short-acting paralytic to prevent coughing or moving during the procedure.
- Doctors and nurses prepare someone for the procedure by lying them faceup, with a towel or roll supporting the neck. They’ll cover the person with a surgical drape, sterilize the surgical site, and apply a local anesthetic to numb the area.
- The surgeon will use a scalpel to make a small, 1.5-millimeter incision into the neck.
- They’ll pierce the trachea with a needle and thread a long thin guidewire through it.
- They’ll use the guidewire to insert a dilator that helps create an opening large enough for the tracheostomy tube to fit through.
- The trach tube will pass through the dilator into the trachea. Doctors may use an endoscope (a tiny camera on a flexible tube) to ensure the tube is in the proper position.
- Doctors will secure the trach tube with sutures or tape, so that no air can escape.
- They will then remove the intubation tube (if necessary) and work quickly to switch the ventilator from the old tube to the new tube.
- Finally, a respiratory therapist will test the trach tube to ensure it’s working properly.
Professionals in the room
The healthcare professionals you need may differ depending on the person’s medical history and condition. They may include:
- a general surgeon
- an otolaryngologist, also called a neck and head surgeon
- an anesthesiologist to administer local anesthetic
- a respiratory therapist to provide assistance with breathing
- a radiologist to take and interpret ultrasound images and X-rays if needed
- nurses to monitor the person’s condition before, during, and after the procedure
Immediately after the procedure, doctors and nurses will monitor the person to ensure that they’re breathing well.
The person may need to spend several days in the hospital as the body heals from the procedure. If you’re heading home, you may learn how to care for the tracheostomy tube and maintain it properly. This includes suctioning, cleaning it regularly, and changing parts as needed.
If doctors insert a tracheotomy speaking valve, the person might need to see a speech therapist in the following weeks to learn how to speak with the trach.
According to a 2020 article, it typically takes about 1 week for the opening created by PT to heal completely. During this time, doctors may replace the tracheostomy tube if necessary. You can usually return home and continue caring for the tracheostomy tube independently, with assistance from family members, or with home healthcare professionals.
PT is a relatively safe and effective procedure, with success rates ranging from
A
According to
- bleeding
- pneumothorax (collapsed lung)
- pneumomediastinum, or trapped air in the chest
- narrowing of the airway
- scarring
- thyroid injury
There are also experience adverse effects or implications that show up after some time. These include infection, tracheal tube displacement, and tracheal stenosis.
Because the procedure may affect the ability to speak or breathe normally, anxiety and depression can be a risk. In this case, you should speak with a doctor about your concerns.
While both PT and surgical tracheostomy involve creating a hole in the neck, there are several key differences between them. But there’s no evidence showing that one is better than the other.
| Percutaneous tracheostomy | Surgical tracheostomy |
|---|---|
| Uses local anesthetic and sedation | Uses general anesthesia |
| Typically performed in a hospital room | Typically performed in an operating room |
| Shorter procedure time | Longer procedure time |
| Surgeons use a needle to puncture the trachea | Surgeons make an incision in the trachea |
| Surgeons often use a dilator to widen the hole (stoma) | Surgeons often use a stitch or retractor to hold the airway open |
| Stoma heals in about 1 week | Stoma may take longer to heal |
| Lower rates of bleeding and infection | Slightly higher rates of bleeding and infection |
| While rare, risks include collapsed lung, infection, and damage to the surrounding tissue and structures | While rare, risks include collapsed lung, infection, and damage to the surrounding tissue and structures |
PT involves opening the windpipe to provide an airway for breathing.
It’s a relatively safe procedure, but there are some risks. Downtime is shorter than a traditional surgical tracheostomy but may require some time at the hospital.
