Tracheostomy patients are normal patients who have had problems with their airway due to things like cancer, trauma, or being in intensive care for a long period of time where the patient had to have breathing assistance done, and tracheostomies have been put in place to assist their breathing. The tracheostomy patient will have a little stoma in the centre of the neck with a little plug on top of it, and quite often, a little shield goes over the top to stop dust getting actually into the tracheostomy.
The tracheostomy, basically, is a shortening of the airway. It allows oxygen to go through the neck and into the lungs rather than actually through the upper airways. So if we need to give the upper airways a rest or the upper airways have been damaged or we have got problems due to cancers and growths and tumours and we need to actually come below the upper airway, the tracheostomy is fitted. Tracheostomy patients can breathe through their mouth and nose as well as the stoma in the neck. So if we are involved in a resuscitation or a patient that has breathing problems, quite often, it is good form to actually put an oxygen mask over the face and nose, but also one over the actual stoma in the neck, and obviously, if we are doing resuscitation and that sort of stuff, we have to take into consideration there is now three points of entry for oxygen: The nose, the mouth, and the tracheostomy.
Tracheostomies, because they are so close to the lungs, can get congested where you would cough up rubbish on your chest. They can cough up rubbish, we can get water into the stomas, so they have to be very, very careful on positioning and how we treat the patient with a stoma is important. It is their main breathing pipe so we have to make sure that that pipe is kept clear and clean, exactly the same way we would do with the airway, breathing of the nose and mouth. Tracheostomies can be removed and the entrance and exits stitched up and they can revert back to nose and mouth, but they are quite rare and don’t normally give you a problem as long as you recognise that it is a port of entry and exit for oxygen.