What is Transtracheal Oxygen Therapy?

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 quite different. 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.  It provides supplemental oxygen through a small catheter which enriches the air inspired through the nose and mouth. The Modified Seldinger procedure (MST) is a medical procedure that can be performed by a pulmonary physician on an outpatient basis while the Fast Tract (FT) procedure is done by a surgeon in an outpatient surgery department. Both procedures are safe, cause little discomfort, and provide a small tract for insertion of the SCOOP catheter. Both procedures are reversible, but few patients choose who experience transtracheal oxygen choose to go back to nasal prongs.

The Transtracheal Program extends over a 2-3 week period utilizing the Fast Tract procedure, and about 6 to 8 weeks using the MST. The program consists of four phases:

Phase I.

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.

Phase II.

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.

Phase III.

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.

Phase IV.

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.