Tracheostomy & Feeding Tube Care at Home: A Family Guide

Going home after major oral cancer surgery is a milestone for the patient and for the family. It can also feel frightening when your loved one comes home with a temporary tracheostomy, a feeding tube, or both, and you are suddenly the person responsible for them.

Operations on the tongue, floor of the mouth or jaw often need these temporary supports. A tracheostomy keeps the airway safe while the mouth and neck are swollen. A feeding tube lets the patient receive nutrition and fluids while the wounds heal and swallowing recovers. Most families learn the routine within days. It takes a steady schedule, clean hands and knowing what to watch for, not a medical degree.

Please read this first. Every patient's tubes, equipment and needs are different. This guide is general information and does not replace the hands-on training and written instructions from your hospital team. If anything here differs from what they told you, follow their advice and ask them to explain.

Why these tubes are needed

1. Airway protection. Surgery causes swelling in the mouth, tongue and neck. A tracheostomy is an opening in the windpipe below the vocal cords that gives air a secure route past the swollen area.
2. Wound protection. Fresh stitches and flap reconstruction inside the mouth need rest from chewing and food particles in the early days.
3. Avoiding aspiration. Swallowing is temporarily altered after surgery. Food or liquid that goes the wrong way into the lungs can cause pneumonia.
4. Nutrition. Healing needs calories, protein and fluid. A feeding tube delivers them straight to the stomach, which helps limit weight loss.

Tracheostomy care at home

After oral cancer surgery, a temporary tracheostomy is often removed before the patient leaves hospital. Some patients do go home with one. Air breathed through a tracheostomy skips the nose and throat, so it is not warmed, filtered or moistened, and the care centres on keeping the tube clean, the airway clear and the skin healthy.

Cleaning the inner cannula

Many tubes have a removable inner tube that collects mucus and needs regular cleaning to prevent blockage.

• How often: as often as your nursing team advises, and sooner if breathing sounds rattly or laboured.
• General steps (follow the method you were taught):
  1. Wash your hands well, and wear clean gloves if advised.
  2. Hold the outer flange steady against the neck, then unlock and remove the inner cannula.
  3. Clean it with the brush and solution the hospital recommended, removing mucus inside and out.
  4. Rinse it as instructed.
  5. Check for cracks or leftover debris, then lock it back. If you have a spare inner cannula, use it while the other is being cleaned.

Suctioning

If the patient cannot cough mucus out well, suctioning keeps the airway clear. Do this only if the hospital team trained you.

• Signs it may be needed: rattling or gurgling from the tube, visible mucus at the opening, faster breathing, restlessness or anxiety.
• Safety points:
  1. Use the pressure, catheter size and depth your nurse set and showed you. Never push the catheter further than you were taught.
  2. Apply suction only while pulling the catheter out, and keep each pass short, usually no more than 10 to 15 seconds.
  3. Let the patient rest and breathe between passes.
  4. Clean the equipment afterwards as instructed.
  5. If suctioning does not clear the airway and breathing remains difficult, treat it as an emergency (see the red flags below).

Humidification and the skin around the tube

Without natural humidification, secretions turn thick and form crusts.

• Humidification: use a humidifier or an HME filter over the tube opening as your team advises, and encourage fluids within any limits the doctors have set.
• Stoma skin: check daily for redness, breakdown or foul discharge. Clean with the solution and gauze you were shown, use the dressing your nurse recommends under the flange, and keep the ties secure. Your nurse will show the right tightness, commonly about one finger's width between the tie and the neck. Where possible, two people should change the ties, so that one can hold the tube steady.

Feeding tube care

Depending on the operation and expected recovery, nutrition may be given by a nasogastric (NG or Ryle's) tube or a percutaneous endoscopic gastrostomy (PEG) tube.

General routine

Whether the dietitian has advised commercial formula or home-prepared liquid feeds, the same safety principles apply. The amounts, timing and water flushes must come from your written feeding plan.

1. Position. Sit the patient upright, ideally in a chair, at least 30 to 45 degrees, during the feed and for the time your team advises afterwards, often 30 to 60 minutes. Never feed someone lying flat.
2. NG tube position. Before every feed, check that the mark at the nostril has not moved. If the tube seems to have slipped, or the patient coughs, chokes or struggles to breathe, do not feed and contact the team. Do any aspiration checks only if you were taught them.
3. Flushing. Flush with the amount of clean water your team advises, before and after feeds and medicines, to prevent blockage.
4. Speed. Give feeds at the pace you were shown. Too fast can cause bloating, nausea and vomiting.

Medicines through the tube

• Ask the doctor or pharmacist which medicines come as liquids and which tablets may be crushed. Some must never be crushed.
• Do not mix medicines into the feed. Give them one at a time, flushing with water between each, as instructed.

For ideas on what to give and how to protect weight, see our guide to nutrition during oral cancer treatment.

Worried about caring for a tube at home? Dr. Pradeep S. and Dr. Kalpa Pandya see patients at Apollo Main Hospital, Greams Road, Chennai. Book a consultation or call +91 96633 03747 during working hours for non-urgent questions about recovery after oral cancer surgery. This number is not an emergency line. For breathing difficulty, heavy bleeding or a tracheostomy tube that has come out, call 108 or go to the nearest emergency department.

An example daily routine

Agree the real timings, feed amounts and cleaning frequency with your treating team. This is only an example of how families organise the day.

Common problems and what to do

Blocked feeding tube

Causes include too little flushing, thick feeds or poorly dissolved tablets. Try a gentle warm-water flush with the syringe and technique your nurse showed you. Never push wires or sharp objects and never force it. If it stays blocked, contact your treating team or hospital the same day, as no feeds, fluids or medicines can pass until it is cleared.

Mucus plugging in the tracheostomy

Dry air, too little fluid or missed cleaning are common causes. Remove and clean or change the inner cannula, and suction as you were taught (use saline drops only if your care team has advised them), and check the humidification. If the patient is still struggling to breathe, call 108 or go to the nearest emergency department at once.

Irritated skin around the tube

Moisture from secretions or leaking feed is the usual cause. Keep the skin clean and dry, change damp dressings promptly and ask your nurse before using any cream. Report spreading redness, swelling or pus.

Tube displaced

• Feeding tube: do not force it back in or use it for feeds. Cover a PEG opening with clean gauze and contact your treating team or hospital the same day, because the PEG track can begin to narrow within hours. An NG tube that has come out should be replaced by the team.
• Tracheostomy tube: this is an emergency. Sit the patient upright, keep the opening clear and call 108 or go to the nearest emergency department straight away, even if breathing seems comfortable. Only reinsert a spare tube if the hospital team trained you to do so.

Red flags: get urgent help

Call 108 or go to the nearest emergency department immediately, then inform your treating team, if there is:

• Breathing difficulty: fast or laboured breathing, gasping, blue or grey lips, noisy breathing that does not improve after cleaning the inner cannula and suctioning, or a tube that stays blocked.
• A tracheostomy tube that has come out or partly out.
• Bleeding: bright red blood from the tracheostomy, the mouth or the neck wound. Small streaks in mucus can be normal, but anything more is not.
• Severe or worsening signs of infection or illness: high fever with shivering or drowsiness, rapidly spreading redness or swelling, or severe abdominal pain with a hard, swollen belly.

Contact your treating team or hospital the same day for:

• A blocked or dislodged feeding tube, or when the patient cannot take feeds, fluids or medicines.
• Fever of 38°C (100.4°F) or more, foul discharge, persistent vomiting or leaking around a PEG tube.

Our page on emergency symptoms after oral cancer treatment lists more warning signs. Keep your hospital's contact numbers and the nearest emergency department's address written down and visible.

Before you leave hospital

A good discharge makes home care much easier. Before going home, ask your team to:

• Show you every task (cleaning, suctioning, dressing, feeds, flushes) and watch you do it.
• Give written instructions, with the names and sizes of your tubes, and a spare of what you need.
• Tell you which problems need an emergency visit and who to call for the rest.
• Confirm the date of your next review, and who will arrange removal of the tubes.
• Explain what to do if the power fails, for example for a suction machine or humidifier.

It also helps to share the work. Looking after a patient day and night is tiring, and caregivers who rest and ask for help make fewer mistakes.

Communication, speech and swallowing

Losing voice for a while is frustrating for the patient. Whiteboards, a phone or picture cards help. When the treating team approves, a one-way speaking valve lets air pass up across the vocal cords so the patient can speak. It must be used only as instructed.

Moving off the tubes often involves therapy. Speech and swallowing therapists in the hospital team help retrain tongue and throat movement. See our guides to speech and swallowing therapy and recovery and rehabilitation after oral cancer. Before a feeding tube is removed, the team may check swallowing safety with a bedside assessment, a camera swallow test (FEES) or an X-ray swallow study.

Coming off the tubes

As swelling settles and eating improves, the team removes the supports step by step.

1. Tracheostomy removal (decannulation). The tube is usually downsized or capped for a period under supervision to confirm comfortable breathing through the natural airway. Once safe, the team removes it, covers the opening with a dressing, and it usually closes by itself within a week or two.
2. Feeding tube removal. When swallowing is safe and enough food and fluid is taken by mouth to keep weight steady, the team removes the tube.

For the bigger picture, see our oral cancer surgery recovery timeline.

Support from the surgeons in Chennai

Dr. Pradeep S. (MDS, FHNS, FIBCSOMS, PGDCR) is an oral and maxillofacial surgeon with a head and neck surgical oncology fellowship from HCG Manavata Cancer Centre, Nashik, and more than 15 years' experience in oral, head and neck cancer surgery. He and Dr. Kalpa Pandya see patients at Apollo Main Hospital, Greams Road, Chennai, and work alongside the hospital's nursing, dietetic and speech therapy teams during recovery. Jaw reconstruction with a free flap is planned with a reconstructive colleague.

If you are preparing for surgery, or caring for someone after it, ask your team early about home care and rehabilitation. You can read more on recovery and rehabilitation after oral cancer, or book an appointment to discuss your family member's recovery. For emergencies, always go to the nearest emergency department.

References

1. Mitchell, R. B., et al. "Clinical Consensus Statement: Tracheostomy Care." Otolaryngology-Head and Neck Surgery, 2013;148(1):6-20.
2. Arends, J., et al. "ESPEN guidelines on nutrition in cancer patients." Clinical Nutrition, 2017;36(1):11-48.
3. National Comprehensive Cancer Network. NCCN Guidelines: Head and Neck Cancers (current version), nccn.org.