How to unclog a peg tube with resistance?


#1

I recently met a peg tube that wasn’t flushing normally. In school, we learned that you shouldn’t even have to push the piston and that fluids and meds should be able to simply flow into the stomach via gravity. I had a patient who had a newer peg tube placed but still found some intense resistance at first.


#2

Before you do anything, you need to check that the g tube is still in the right place. If the patient had been pulling at it, or you see weird discharge, bleeding, or anything else unusual, then I would want confirmation that it’s even in the stomach still.

Assuming it is in the right spot, typically, the causes of a clogged peg tube involve meds that were not properly dissolved and became lodged in the tube or peg tube feed that has been sitting in the tube and not flushed with water before clamping. Either of these can create a blockage that will lead to significant resistance when you go to flush the peg tube.

To fix these issues, it may be necessary to perform some back and forth flushing like one would to break up a clot in a patient undergoing CBI. Another popular fix is to use soda because the carbonation can help break down the blockage. I would also advise that you massage the tube to try to break up the contents and try to flush during this tube massage.

Also, always use warm water when dealing with peg tubes. It will help dissolve your meds better, it will flush and remove any built up gunk better, and it will feel better for your patient.


#3

I’ve used carbonated drinks like Coke even though it’s not advised but I’ve seen GI docs do it. Whatever works I guess.


#4

Does anyone know why that’s not advised? Does it break down the material that the peg tube is comprised of? Stomach irritation maybe? I’ve seen Coke get oil out of concrete and remove rust from metal, so it could well be a bad idea.