Tracheostomy

1. Physical examination: The doctor will check the motion of the patient’s neck. The patient will be evaluated physically and the symptoms, medical history, and family history of the patient are noted.
2. Blood tests: It helps in the diagnosis of certain underlying medical conditions.
3. Electrocardiogram or ECG: The electrical activity of the heart can be recorded using this test.
4. Imaging tests: X-rays, CT scans, and MRI scans are the different types of imaging tests that help in producing clear pictures of the internal organs of the body.
   

A tracheostomy procedure is usually done under general anesthesia (the patient will be put to sleep during the procedure). However, if the surgeon is skeptical about the airway becoming compromised due to general anesthesia, or if the procedure is being performed on an emergency basis, the procedure may be performed under local anesthesia (the treatment area is numbed locally).

The type of tracheostomy performed will vary depending on the reason for undergoing the procedure, and whether the procedure was done on an emergency basis, or it was a pre-planned procedure.

Tracheostomy may be performed in the following two ways:

1. Surgical tracheostomy: 

• The surgeon will first make a horizontal incision through the skin at the lower portion of the front of the neck.
• The surrounding muscles will be carefully pulled back.
• A small part of the thyroid gland is cut to expose the trachea or windpipe.
• The surgeon will then create a tracheostomy hole at a specific spot on the trachea, near the base of the neck.
• A tracheostomy tube will then be inserted into the hole.
• A neck strap is then attached to the face plate of the tracheostomy tube to prevent the tube from slipping out of the hole.
• Temporary sutures are then given to secure the faceplate to the neck skin.

2. Minimally-invasive or percutaneous tracheostomy:

• The doctor will first make a small incision near the base of the front of the neck.
• A special lens will then be fed through the mouth so that the surgeon can view the inside of the throat.
• The surgeon will then guide a needle into the windpipe to create a tracheostomy hole.
• This hole will then be expanded to an appropriate size to insert the tracheostomy tube.
• A tracheostomy tube will then be inserted into the hole.
• A neck strap is then attached to the face plate of the tracheostomy tube to prevent the tube from slipping out of the hole.
• Temporary sutures are then given to secure the faceplate to the neck skin.

The risk of tracheostomy can be divided as -

1. Immediate risks: 

• Bleeding
• Displaced tube
• Damage to the surrounding structures- thyroid gland, windpipe, nerves of neck
• Air in the lungs and chest wall ( Pneumothorax ), lung collapse, breathing problems
• Subcutaneous emphysema
• Hematoma ( blood collection ) in the neck causing bleeding difficulties

2. The long term risks: 

• Scarring, narrowing or damage to the trachea
• Tracheostomy tube obstruction
• Displaced trachea
• Abnormal fistula formation between trachea and oesophagus,which may cause food and fluids to enter the lungs
• Infections in the trachea and bronchial tubes
• Infections at the site of the tracheostomy
• Pneumonia (due to infection in the lungs)

• A chest x-ray will be taken to check that the tracheostomy tube is in its correct place and that there are no complications.
• Antibiotics may be given to reduce the chances of infection.
• You will be taught how to care for and clean in and around the tracheostomy tube.
• It may take a couple of days for you to get used to breathing through the tracheostomy tube and it may be difficult to speak at first. If the tube can allow some air to escape and then pass over the vocal cords, you will be able to speak by placing a finger over the tube.
• Swallowing may be difficult while you are healing. During this time, you will receive nutrition intravenously (injected into the vein), through a feeding tube, or a tube that is inserted directly into the stomach. You may later need assistance from a speech therapist to help you in swallowing.
• You will most likely be discharged from the hospital after three to five days of the tracheostomy procedure, provided that there are no complications.

Home remedies:

1. You can use warm compresses to relieve the pain at the site of the incision.
2. The inner cannula (tube) portion of the tracheostomy tube needs to cleanse whenever it gets blocked due to secretions. This may be needed once a day or several times a day.
3. Keep the surgical area dry and clean. You can wear a scarf over the opening and when stepping out. Avoid any contact with food particles, water, and powdery substances.
4. You need to have a humidifier attachment for approximately one month after the surgery because the trachea is exposed to dry air.
5. Avoid strenuous and vigorous activities for six weeks after the surgery.

Benefits:

The advantages of tracheostomy include:

• Improved comfort
• Quick rehabilitation
• Less need for sedation
• Good nutrition
• Early communication
• Easy weaning off of mechanical ventilation 

Cost of tracheostomy in India- 

The cost of a tracheostomy in Mumbai is between INR 35,000 to INR 85,000.
The cost of a tracheostomy in Delhi is between INR 30,000 to INR 80,000.
The cost of a tracheostomy in Bangalore is between INR 30,000 to INR 80,000.
The cost of a tracheostomy in Chennai is between INR 25,000 to INR 75,000.