From the Guidelines
To manage a J-tube occlusion, routine water flushing after feedings can prevent tube occlusion and is especially relevant in small-caliber tubes, like jejunostomies, and if the tube does become clogged, simple water flushing can help regain patency. The use of percutaneous tubes instead of nasal tubes for long-term needs can reduce mechanical complications of Home Enteral Nutrition (HEN), including blocking and dislodgement 1. According to the ESPEN guideline on home enteral nutrition, general EN complications applicable to patients on HEN can be classified as mechanical, aspiration, gastrointestinal, metabolic, and stoma complications 1.
Causes of J-tube Occlusion
- Mechanical complications, such as dislodgement and obstruction of the tubes, are quite frequent in patients on HEN and include:
- Dislodgement
- Obstruction of the tubes
- These complications are more frequent in nasal tubes, especially nasojejunal tubes, than in PEG tubes 1
- Patients with neurological diseases had significantly more complications than cancer patients, with mechanical complications being the most frequent 1
Management of J-tube Occlusion
- Routine water flushing after feedings can prevent tube occlusion and is especially relevant in small-caliber tubes, like jejunostomies 1
- If the tube does become clogged, simple water flushing can help regain patency 1
- In cases of persistent obstruction, some experts recommend infusion with cola-containing carbonated drinks or pancreatic enzymes may unclog the tube, however, this maneuver is not recommended due to the sugar content of sodas enhancing the risk of tube contamination with bacteria 1
- Others recommend the usage of 8.4% w/v sodium bicarbonate solution to unblock the tube; however, this is also not evidence-based medicine 1
- If necessary, a guide wire or commercially available tube declogger can be used by an expert in case of PEG tubes 1
Prevention of Future Occlusions
- Flush the tube with water before and after medication administration
- Crush pills completely and dissolve in water
- Avoid mixing medications together
- Flush with water between different medications
- Regular flushing every 4-6 hours with water helps maintain patency, especially when the tube is not in active use 1
From the Research
Causes of Jejunal (J) Tube Occlusion
- Formula clotting is a common cause of J-tube occlusion, as seen in 23 of 24 instances where the pancreatic enzyme solution was successful in restoring tube patency 2
- Tablet impaction, knotted feeding tube, and foreign objects (such as tomato seeds) can also cause J-tube occlusion 2
- Dislodgement and obstruction are the most common causes of J-tube replacement, with rates of 35.6% and 22.2%, respectively 3
Management of Jejunal (J) Tube Occlusion
- Using an activated pancreatic enzyme solution to clear obstructed feeding tubes has been shown to be effective in 72% of cases 2
- Water injection can also be used to clear obstructions, with a success rate of 12 cases out of 44 attempts 2
- An arterial embolectomy catheter can be used to unblock a clogged jejunostomy tube, providing a safe and cost-effective method of salvage 4
- Tissue-type plasminogen activator (t-PA) has been used to thrombolysis in occluded peritoneal dialysis catheters, but its use in J-tube occlusion is not well established 5
- Removing the current device and replacing it, or removing the obstruction from the tube, are also options for managing J-tube occlusion 6