How a tracheostomy is formed 

A tracheostomy may be formed during either a planned or emergency procedure.

Planned tracheostomy

Many tracheostomy procedures are performed in intensive care, where there is time to prepare for the procedure and explain what is happening. 

A planned tracheostomy can be carried out in one of two ways:

  • a percutaneous tracheostomy
  • an open tracheostomy

Percutaneous tracheostomy

A percutaneous tracheostomy is usually carried out under general anaesthetic (where you are asleep) in an intensive care unit.

Your doctor first makes a small cut (incision) in your throat, or inserts a thin needle through your throat and into your windpipe (trachea).

A wire is then passed into your windpipe through the needle or incision and is used to guide a specially shaped instrument called a dilator into the opening.

The dilator helps open up the hole in your throat and windpipe so a tracheostomy tube can be inserted.

In some cases, a thin telescope (endoscope) is passed down your throat during the procedure so your doctor can make sure everything is in the right position.

Open tracheostomy

An open tracheostomy is usually carried out in an operating theatre under a general anaesthetic.

The surgeon will make a cut in the lower part of your neck and part the tissues covering your windpipe. They will then make an incision in the wall of your windpipe so the tracheostomy tube can be inserted through the opening.

This technique is used when it is not safe or possible to perform a percutaneous tracheostomy. For example, it may be recommended:

  • for children younger than 12 years old
  • when the normal structure of the neck has been affected by something, such as a tumour or a collection of blood
  • when the person is very overweight and has a large amount of fat in and around their neck

After the procedure

After both procedures, an X-ray may be taken to check the tube is in the right position. Antibiotics may be prescribed to reduce the risk of an infection at the site of the incision.

If you are unable to breathe unaided, the tracheostomy tube can be attached to a ventilator (a machine that supplies oxygen to assist with breathing) to increase the flow of oxygen to your lungs.

When the tracheostomy tube is in position, a dressing is placed around the opening in your neck, and tape or stitches will be used to hold the tube in place.

Emergency tracheostomy

An emergency tracheostomy may be needed if a person's airway suddenly or unexpectedly becomes blocked after an accident or injury, or if they have respiratory failure (a serious and life-threatening condition where the lungs cannot provide enough oxygen for the rest of the body).

An emergency tracheostomy is sometimes carried out using local anaesthetic if there is not enough time to use a general anaesthetic, or if the procedure is not being carried out in a hospital. If local anaesthetic is used, the person will be awake throughout the procedure but shouldn't feel severe pain.

The person will be placed on their back and a rolled-up towel or something similar will be positioned under their shoulders. This stretches out their neck, making it easier to see the structure of the throat.

A cut will be made in the skin of the neck and underlying tissue. The tracheostomy tube will be inserted into the airway and may be connected to a ventilator.

How long will I need a tracheostomy for?

For some people, the tracheostomy tube may be removed in hospital after a few days or weeks when they are able to breathe, protect their airway, and clear fluids unaided. For others, it may be permanent or needed for a longer time.

If the tube is temporary, the opening in your neck will be covered with a dressing when it's removed. This opening will usually take a few weeks to heal completely, and afterwards you may have a small scar where the opening was.

If you need a tracheostomy in the long term, you may be able to go home with the tube in place. Your care team will make sure you are confident about looking after your tracheostomy before you are discharged.

Read more about living with a tracheostomy.

Page last reviewed: 26/01/2015

Next review due: 26/01/2017