There are many of misconceptions about transtracheal oxygen therapy, probably because the word "transtracheal" sounds a bit like "tracheotomy". We would like to reassure you that the two procedures are as different as night and day. The tracheotomy is normally an emergency procedure, whereas transtracheal oxygen therapy is a scheduled procedure involving the support of an entire team that includes you, your family, your doctor, your respiratory therapists, and your home care company, among others. Transtracheal oxygen therapy is a superior method of delivering oxygen directly into the lungs by a small, flexible catheter which passes from the lower neck into the trachea or windpipe. There are two very different procedure techniques currently being utilized. Although only a very few physicians continue to use the Modified Seldinger approach (MST), it is still offered in some parts of the United States. While the Fast Tract (FT) procedure is currently favored by the vast majority of physicians, both procedures are safe, cause little discomfort, and for most individuals is more effective in getting oxygen into the blood than nasal cannula. More oxygen in the blood means more activity, more energy and better health for most patients.
One common question many patients ask is about reversibility. If for any reason you wish to return to nasal cannula, it is as simple as removing the catheter and putting the cannula back on. The catheter tract closes itself (kind of like a pierced ear closing if you don't wear earrings) with no additional procedure normally required. We strongly recommend that you consult with your physician before removing your catheter permanently. After a tract has closed, the only way to restart transtracheal oxygen therapy is to redo the procedure.
The Transtracheal Program extends over a 2-3 week period utilizing the Fast Tract procedure, and about 6 to 8 weeks using the MST. In the course of this program, you will pass through four phases:
During this phase you will have an opportunity to learn about the pros and cons of transtracheal oxygen before you decide to go ahead with the procedure to place the catheter. You can visit with the doctors, nurses, and respiratory therapists, as well as patients who have already begun transtracheal oxygen and ask all the questions you want. A history, physical examination and several laboratory tests will be done to determine if transtracheal oxygen can be recommended for you. If your doctor feels you are medically stable your procedure can be scheduled at a mutually convenient time. Patients who opt for the Fast Tract procedure should be ready to spend the night in the hospital.
You will need to arrive at the hospital (with an empty stomach) at the time you are given to check in. After checking in, you will take any medications prescribed by your physician. If your physician elects to do the MST, the simple procedure is performed while you are sitting in a chair. Most people have reported that the local anesthetic makes the procedure more comfortable than a common blood gas. The procedure itself takes perhaps 20-30 minutes. After another hour of observation, you will probably be sent home with a small tube (called a "stent") in the newly formed tract. Oxygen is not given through the tube which serves to form the tract for the transtracheal oxygen catheter. A mild to moderate tickle cough is normal for the next day or two. You may also have mild to moderate pain which usually responds to plain Tylenol. Your doctor will give you instructions on your specific medications and what to do for possible problems. If the Fast Tact procedure is performed, you will be moved to the operating room, where the procedure will be performed using local anesthesia and IV medication to make you very comfortable. The Fast Tract procedure takes 45 minutes to an hour. You will be moved from the operating room to the recovery room, and then to the room in which you will be spending the night.
About a week after the MST procedure, you will return and the non-functioning tube (stent) will be exchanged for a functioning transtracheal catheter. Oxygen is then connected to the catheter, and the nasal cannula is removed. You will be instructed about proper care of your tract opening, catheter and hose. Learning how to do these things is simple and takes about an hour. Because the tract is still healing (immature), you will clean the catheter in place for the next 5-7 weeks. Your doctor, therapist or nurse may remove the catheter several times to strip mucus away. If you have had the Fast Tract performed, your stent will be removed the morning after your procedure. Transtracheal oxygen will be initiated that morning, and you will be discharged on TTO therapy. You will have 4 scheduled visits over the next 2 weeks.
After about 6-8 weeks (MST), or 2-3 weeks (FT) your doctor will determine if your tract is fully healed (mature) You will receive instruction on how to remove your catheter for cleaning. There is a great deal of flexibility built in to the TTO program of care. Early in phase 4 your doctor will customize a cleaning program that meets your specific cleaning needs. Your transtracheal catheters must be replaced every 90 days, and your doctor will need to see you periodically for check-ups.