How to Unclog a PEG Tube

To unclog a PEG tube, first attempt flushing with warm water, and if unsuccessful, use an alkaline solution of pancreatic enzymes. 1

First-Line Approach: Water Flushing

Start by attempting to flush the tube with 40-60 ml of warm water, which is particularly effective for clearing most blockages 2
Use gentle pressure when flushing to avoid tube damage; never force the flush if resistance is significant 1
Ensure the patient is positioned upright during the procedure to minimize risk of aspiration 1

If warm water flushing fails, use an alkaline solution of pancreatic enzymes, which has shown 96% success rate in clearing formula-related clogs 1, 3
For persistent blockages, a guidewire or commercially available tube declogger may be used by healthcare professionals with expertise in managing enteral tubes 2, 4
Passing a soft guidewire may help clear the blockage but should be done carefully to avoid tube perforation 1

Carbonated drinks (including cola), pineapple juice, and sodium bicarbonate solution should be avoided as they may cause tube degradation 1, 2
These solutions lack evidence-based support and the sugar content in carbonated drinks enhances the risk of bacterial contamination 2, 4
Avoid using excessive force when attempting to clear blockages as this may damage or rupture the tube 1

Flush the tube with 40 ml of water before and after every feed or medication administration 1, 2
Medications administered through the tube should ideally be in liquid form (elixirs or suspensions) rather than syrups 1
Establish medication compatibility before administration; hyperosmolar drugs, crushed tablets, potassium, iron supplements, and sucralfate are particularly likely to cause blockages 1
Loosen and rotate the gastrostomy tube weekly to prevent blockage from gastric mucosal overgrowth 1

If all unclogging attempts fail, professional assessment may be needed for tube replacement 1, 2
Seek immediate help if there are signs of tube deterioration, peristomal leakage, or infection 1
For mature stoma tracts (>4 weeks old), direct replacement through the existing tract should be attempted before the tract closes completely if the tube cannot be unclogged 4

Unlike nasogastric tubes, PEG tubes can sometimes be occluded by gastric mucosal overgrowth, which may require different management approaches 1
For PEG tubes with jejunal extensions (PEGJ), do not rotate the tube as this may damage the jejunal extension; only push in and out weekly 2
If the tube has splits or breakages, it may be possible to cut the tube and replace the funnel/connector lower down rather than replacing the entire tube 1