What are the troubleshooting steps for a clogged percutaneous endoscopic gastrostomy (PEG) tube?

From the Guidelines

To troubleshoot a clogged PEG tube, first attempt to flush it with 30-60 mL of warm water using gentle pressure, as recommended by recent guidelines 1. If this doesn't work, try the "push-pause" technique: gently push the syringe plunger, pause when resistance is felt, then pull back slightly before pushing again. For persistent clogs, some experts recommend using a guide wire or commercially available tube declogger, as suggested in the ESPEN practical guideline on home enteral nutrition 1. However, it's essential to note that using cola-containing carbonated drinks or pancreatic enzymes to unclog the tube is not recommended due to the risk of tube contamination with bacteria 1. To prevent future clogs, flush the tube with 30 mL of water before and after each medication or feeding, crush medications completely and dissolve them thoroughly in water, and avoid mixing medications together, as emphasized in the ESPEN guideline on home enteral nutrition 1. If medications are thick or sticky, dilute them adequately. Regular flushing with water every 4-6 hours when the tube is not in use can also help prevent blockages. Some key points to consider when troubleshooting a clogged PEG tube include:

• Using gentle pressure when flushing the tube to avoid rupture
• Avoiding the use of excessive force or harsh chemicals to unclog the tube
• Regularly flushing the tube with water to prevent blockages
• Properly caring for the tube and surrounding skin to prevent complications, as outlined in the ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG) 1. If these measures fail to clear the obstruction, contact healthcare providers as the tube may need replacement.

From the Research

Troubleshooting a Clogged Peg Tube

To troubleshoot a clogged peg tube, several methods can be employed, including:

• Using warm water flushes to clear the blockage
• Utilizing an enzyme treatment, such as pancreatic enzymes, to break down the clog
• Employing an actuated mechanical occlusion clearing device to physically remove the obstruction
• Preventing clogs through regular flushing with water or other agents

Causes of Clogs

The causes of clogs in peg tubes can vary, but common factors include:

• Formula clotting, which can be caused by the drying out of formula in the tube 2
• Tablet impaction, where medications or other tablets become stuck in the tube 2
• Knotted feeding tubes, which can cause kinking and blockage 2
• Coagulated protein, such as dried-out protein, which can make clogs more difficult to clear 3

Methods for Clearing Clogs

Several studies have investigated methods for clearing clogs in peg tubes, including:

• Using pancreatic enzymes to break down clogs, which has been shown to be effective in restoring tube patency 2, 4, 5
• Employing an actuated mechanical occlusion clearing device, which has been shown to be highly effective in clearing clogs 3
• Using warm water flushes, which can be effective in some cases, but may not be as effective as other methods 3, 6

Prevention of Clogs

To prevent clogs from occurring in the first place, regular flushing of the tube with water or other agents can be effective, including:

• Using water flushes, which have been shown to be comparable in efficacy to other agents, while being more readily available and cost-effective 6
• Utilizing pancreatic enzymes as a prophylactic measure to prevent clogs from forming 4