How do you unclog a Gastrostomy (G) tube?

How to Unclog a G Tube

Start by flushing the tube with 40-60 mL of warm water using gentle pressure, which successfully clears approximately one-third of obstructions. 1

Stepwise Algorithm for Unclogging

Step 1: Water Flush (First-Line)

• Attempt warm water flushing with 40-60 mL as the initial intervention 1, 2
• Position the patient upright during flushing to minimize aspiration risk 3, 2
• Use gentle pressure to avoid damaging the tube—never force the flush if you encounter significant resistance 2
• This simple approach resolves about 33% of tube occlusions 1

Step 2: Pancreatic Enzyme Solution (Second-Line)

• If water flushing fails, instill an alkaline solution of pancreatic enzymes, which clears an additional 50% of occluded tubes 1
• The enzyme solution demonstrates a 96% success rate specifically for formula-related clogs 3, 4
• Allow the enzyme solution to dwell in the tube for optimal effect 4
• This approach is superior to other chemical methods for resolving protein-based obstructions 1

Step 3: Mechanical Devices (Third-Line)

• If enzymatic treatment fails, attempt mechanical clearing with devices such as a Fogarty balloon catheter, biopsy brush, or commercially available tube decloggers 1, 3
• Recent research shows actuated mechanical devices achieve 93% success rates and require significantly less time than other methods 5
• These interventions should be performed by healthcare professionals with expertise in enteral tube management 6

Step 4: Tube Replacement (Last Resort)

• Replace the tube only after all other methods have failed 1, 3
• Consider the tube's age and overall condition when deciding on replacement 3
• Most transoral bumper-type gastrostomy tubes can remain in place for 1-2 years with optimal care 1

Critical Pitfalls to Avoid

Ineffective or Harmful Agents

• Do not use carbonated beverages (including cola), cranberry juice, or pineapple juice—these are inferior to water and may cause tube degradation 1, 2, 6
• Avoid sodium bicarbonate solution as it lacks evidence-based support 2, 6
• Never use excessive force when attempting to clear blockages, as this may rupture or damage the tube 2, 6

Special Considerations for G Tubes

• Loosen and rotate the gastrostomy tube weekly to prevent blockage from gastric mucosal overgrowth 2
• However, if your G tube has a jejunal extension (GJ tube), do NOT rotate it—only push in and out weekly to avoid damaging the jejunal component 3, 2, 6

Prevention Strategies

Routine Maintenance

• Flush the tube with 40 mL of water before and after every feed or medication administration 3, 2, 6
• Clean the tube daily with water and regular or antibacterial soap 1
• Use sterile water for flushing when possible to prevent infections 1, 3

Medication Administration

• Use liquid medications whenever possible rather than syrups or crushed tablets 2, 6
• If tablets must be used, crush them to a fine powder and flush thoroughly between different medications 6
• Establish medication compatibility before administration, as hyperosmolar drugs and certain supplements are particularly likely to cause blockages 2

When to Seek Professional Help

• If all unclogging attempts fail, professional assessment is needed for potential tube replacement 2, 6
• Seek immediate help if you observe signs of buried bumper syndrome (difficulty mobilizing the tube, leakage around the insertion site when flushing, abdominal pain, or chronic site infections) 6
• Contact healthcare providers if there are signs of tube deterioration, peristomal leakage, infection, or aspiration 2, 6