A tracheostomy is a small hole and tube placed in your throat to help you breathe. Decannulation is the process to remove this device.
A tracheostomy is a lifesaving procedure that can help you breathe if your airway becomes blocked or damaged or you’re unable to breathe on your own. Tracheostomies consist of a small hole with a flexible tube inserted. This tube allows oxygen to bypass your upper airway and go directly into your windpipe.
These devices may be temporary or permanent.
This article will explore what a tracheostomy is and why you might need one, as well as what to expect when you’re ready for your tracheostomy to be removed — or decannulated.
A tracheostomy is an artificial airway that bypasses the tube you naturally breathe through – your trachea. A tracheotomy is a surgical procedure where a small opening is made in your neck at the trachea. The tracheostomy is the small tube placed into the opening that forms the artificial airway.
A tracheostomy can be temporary or permanent and may be needed for any of the following reasons:
- respiratory failure from a chronic medical condition
- a blockage from a foreign object
- an inherited or congenital abnormal shape or formation
- cancers of the neck
- paralysis or problems with breathing or vocal cords in your neck
- neuromuscular diseases
- severe trauma, injury, or surgeries
- to prevent aspiration
A tracheostomy tube might be placed in an operating room or intensive care unit for emergency airway access or to replace a breathing tube that’s inserted into your mouth.
Endotracheal tubes, which can be placed in your nose or mouth, aren’t meant to provide a permanent airway. If you require intubation and mechanical ventilation for longer periods without the ability to return to natural breathing, your healthcare team may suggest that a tracheostomy be placed.
Conditions such as obstructive respiratory diseases or ongoing critical respiratory illness are common reasons for tracheostomies. The use of this procedure also increased as a result of respiratory complications during the COVID-19 pandemic.
Cannulation is the term used to describe the insertion of a small tube through an opening, so
When an individual with a tracheostomy is decannulated, the tracheostomy tube is removed from the opening in your trachea, and it’s left to heal naturally.
A tracheostomy is usually reversed, or an individual with a tracheostomy is decannulated, when their condition is improved to the point where they’re breathing well on their own, and there’s no longer a concern for the safety of their natural airway.
This could mean that whatever obstruction or condition they developed was fixed or healed or that their respiratory function has improved so that they no longer require mechanical ventilation.
While removing a tracheostomy is a fairly simple process of removing the small tube and closing the hole that was made, getting to the point of decannulation can be more complex.
Before decannulation happens, it’s important to make sure that your natural airway is open, unobstructed, and secure. This usually requires improvements in your abilities to breathe, cough, and swallow, meaning that your respiratory, neurological, and digestive systems must be in coordination with one another.
Your healthcare team will test your readiness for decannulation with a series of tests or trials. Weaning of mechanical ventilation is usually the first step, meaning that you must be able to function while breathing the equivalent of natural air through your own effort.
You may still require some supplemental oxygen, but it’s important that you’re able to perform the function of breathing on your own before the tracheostomy tube is removed.
If you’ve successfully been weaned from the respiratory support of mechanical ventilation, you may also need to pass some tests that check your ability to swallow and manage mucus or secretions. This could include tests to measure the strength and force of your cough, the response of your gag reflex, and where food or water goes when you swallow it.
Once the decision is made that it’s safe to reverse your tracheostomy, there are two main strategies.
Gradual decannulation is one choice and involves the use of progressively smaller tracheostomy tubes that are switched out during the process. Smaller and smaller tubes are used in the tracheotomy incision, allowing it to close gradually until the smallest size is removed.
At that point, the hole left behind from the tracheostomy tube is usually healed around the edges and small in size, so it may be left to close up naturally.
Capping or spontaneous removal
If you already have a small tracheostomy tube, or a decision is made to maintain the tracheostomy site for a period of time, the tracheostomy tube might simply be capped or sealed off. When it’s certain that recannulation won’t be needed due to a recurrence of illness or obstruction, the tube can be uncapped and removed.
There are other instances when a tracheostomy may be capped before decannulation. For example, if you have a tracheostomy for surgery, once you’ve healed enough, it might be capped briefly, maybe overnight, and then you’ll be decannulated in the morning. The hole may be left to close on its own.
The decisions and steps to decannulation in children may be different than those for adults and may involve an airway evaluation in the operating room and a capped sleep study, among other things.
The care of your tracheostomy site — usually called a stoma — depends on how long you had the tracheostomy in place and for what reason. If you have or had excessive respiratory secretions and mucus, it can take longer — and more wound care — for your stoma to heal. Healing can also take longer based on the length of time the tracheostomy was used.
One study found that it took stomas
Sometimes, if a stoma doesn’t close on its own, a surgical procedure called a tracheocutaneous fistula closure may be used to seal your stoma.
Your tracheostomy can be accidentally removed, fall out, or even be removed without a gradual process. The risk in this situation depends on your individual health, why you had the tracheostomy placed to begin with, and where you’re at in the rehabilitation and healing process.
If you’re still dependent on mechanical ventilation and have a tracheostomy that’s accidentally removed, it will likely be replaced immediately. If immediate replacement isn’t possible and you’re not able to breathe effectively, oral intubation with an endotracheal tube is a possibility.
Even with planned or gradual removals, there’s a chance you’ll need recannulation after your tracheostomy is removed. Studies suggest that anywhere from
- excessive carbon dioxide retention (hypercapnia)
- respiratory failure
- secretion accumulation
- unplanned self-decannulation
Your outlook after having a tracheostomy removed will depend largely on the reason it was done in the first place. People who receive tracheostomies due to surgeries that require healing time before a return to typical activities should do well.
If you receive a tracheostomy because of a serious or progressive
People with ongoing respiratory, neurological, or digestive problems may require recannulation at some point, or the decision may be made to maintain the stoma for emergency airway access.
Will my stoma close up completely?
How quickly and seamlessly your stoma heals will depend on how long you had a tracheostomy and your individual healing habits. For most people, a stoma closes about
Will my stoma need to be reopened?
If you have a recurrence of the problem that led you to have a tracheostomy done, there’s a chance you may require recannulation. It’s also possible that you experience a separate problem at some point that requires a tracheostomy to be placed.
Can a tracheostomy be kept indefinitely?
A tracheostomy can be kept in place as long as you need it.
If you require ongoing mechanical ventilation to support your breathing, you may need specialized care to maintain your tracheotomy site and ventilator. A permanent tracheostomy may require tube changes or stoma repair, and you’ll be at risk of various respiratory and other infections, such as pneumonia.
A tracheostomy can be a lifesaving measure if you run into an obstruction in your airway, respiratory failure, or other problems that put your airway at risk. If you do require a tracheostomy, the goal is usually reversal, but it can also be left in place permanently if needed.
If you’re going to have your tracheostomy removed, you’ll go through a series of steps to make sure you’re ready to breathe safely on your own and to help ensure good healing at the insertion site.