How to unclog a Jejunostomy (J) tube

How to Unclog a J-tube

To unclog a jejunostomy (J) tube, first try flushing with warm water, and if that fails, use a pancreatic enzyme solution which can successfully clear formula-related clogs in up to 96% of cases. 1

Step-by-Step Approach to Unclogging a J-tube

First-Line Approach: Water Flush

1. Try flushing the tube with warm water
   • This simple method can successfully clear obstructions in approximately one-third of cases 1
   • Use gentle pressure - never force the flush

Second-Line Approach: Pancreatic Enzyme Solution

If water flushing fails:

1. Prepare a pancreatic enzyme solution (using pancreatic enzyme tablets dissolved in water)
2. Instill the solution into the tube
3. Allow it to work for 15-30 minutes
4. Attempt to flush again with warm water

This method can successfully restore tube patency in approximately 72% of cases where water has failed, and up to 96% of cases where formula clotting is the cause of obstruction 2

Third-Line Approaches (if previous methods fail):

1. Mechanical devices:

   • Use a commercially available tube declogger
   • Consider a Fogarty balloon catheter
   • Use a biopsy brush (requires healthcare professional assistance) 1

2. For persistent obstruction (requires healthcare professional):

   • A guide wire may be used by a healthcare professional 1
   • In some cases, an arterial embolectomy catheter can be used to unblock a clogged jejunostomy 3

Prevention of J-tube Clogs

J-tubes are particularly prone to clogging due to their smaller diameter compared to gastrostomy tubes 1. To prevent clogs:

1. Regular flushing with water:

   • Flush before and after every medication administration
   • Flush before and after every feeding
   • Use fresh tap, cooled boiled, or sterile water 1

2. Medication administration:

   • Use liquid medications whenever possible
   • Avoid crushed tablets, hyperosmolar drugs, potassium supplements, iron supplements, and sucralfate 1
   • Ensure medications are compatible with tube feeding

3. Avoid problematic substances:

   • Do not use carbonated beverages or cranberry juice for flushing as they are inferior to water 1
   • Avoid cola-containing drinks as their sugar content can enhance bacterial contamination 1

Common Pitfalls and Caveats

1. Never force flush a clogged tube - this can cause tube rupture or displacement

2. Avoid certain substances for unclogging:

   • Carbonated beverages and cranberry juice are inferior to water 1
   • Cola drinks may increase risk of bacterial contamination 1

3. Recognize when tube replacement is needed:

   • If the tube remains clogged despite all attempts
   • If there is evidence of tube damage or degradation
   • Tube replacement should be considered as a last resort 1

4. Be aware of causes beyond formula clotting:

   • Tablet impaction
   • Knotted feeding tube
   • Food particles (like seeds) occluding the feeding port 2

J-tube occlusion is a common complication, occurring in up to 35% of patients with small-bore feeding tubes 2. With proper technique and maintenance, most clogs can be successfully cleared without requiring tube replacement.