Clearing a Clogged PEG Tube with Sodium Bicarbonate and Creon
Use warm water (40-60 mL) as your first-line approach to clear the clogged PEG tube, and if this fails, proceed to an alkaline solution of pancreatic enzymes (Creon dissolved in sodium bicarbonate), which achieves approximately 48-96% success in clearing formula-related clogs. 1, 2
First-Line Treatment: Warm Water Flush
- Attempt to flush the tube with 40-60 mL of warm water using gentle, steady pressure 1, 3
- Position the patient upright during the procedure to minimize aspiration risk 1
- This simple approach successfully clears approximately one-third of tube obstructions 4, 5
- Never use excessive force, as this may damage or rupture the tube 1, 3
Second-Line Treatment: Creon with Sodium Bicarbonate
If warm water flushing fails, prepare an alkaline pancreatic enzyme solution using Creon dissolved in sodium bicarbonate solution. 1, 2
Preparation Protocol for Gastric PEG Tubes:
- Open Creon 12,000-24,000 lipase unit capsules and empty the contents into 20 mL of 8.4% sodium bicarbonate solution 6, 2
- Allow the mixture to dissolve for up to 30 minutes to activate the enzymes and dissolve the enteric coating 6
- Lower doses (12,000-24,000 units) dissolve more completely than higher doses 6
- Flush this alkalinized enzyme solution through the tube 2
- This approach has demonstrated 48-96% success rates in clearing occluded tubes, though efficacy varies by product formulation 1, 2
Important Product Considerations:
- Zenpep 20,000-40,000 lipase units dissolves most efficiently in sodium bicarbonate due to uniform granule size and thinner enteric coating 6
- Creon 24,000 units or lower doses achieve complete dissolution at 30 minutes 6
- Higher doses of any pancrelipase product may not completely dissolve 6
Critical Pitfalls to Avoid
Do not use carbonated drinks, pineapple juice, or sodium bicarbonate solution alone (without pancreatic enzymes) as these may cause tube degradation. 1, 3
- Avoid forcing the flush if significant resistance is encountered 1
- Do not use acidic juices or carbonated beverages, which can degrade the tube material 4, 1
- Sterile or cooled boiled water should be used for flushing rather than tap water to prevent infection risk 4
When Conservative Measures Fail
- If the alkalinized enzyme solution fails, mechanical devices such as a soft guidewire, Fogarty balloon, or commercially available tube decloggers may be attempted by experienced providers 4, 1
- Tube replacement should be considered as a last resort after all unclogging attempts have failed 4, 1
- Seek immediate professional assessment if there are signs of tube deterioration, peristomal leakage, or infection 1
Prevention Strategy
- Flush the tube with 40 mL of water before and after every feed or medication administration 1, 3
- Use liquid medications rather than syrups or crushed tablets when possible 1, 3
- Loosen and rotate the gastrostomy tube weekly to prevent blockage from gastric mucosal overgrowth 1, 3
- Ensure at least 5 mm of free tube movement at the external fixation plate to prevent pressure necrosis 3