Clogged G-tube

Indications

• Catheter clogged with medications or feeding solution

Contraindications

• Uncertain position/integrity of tube

Methods for Clearing Obstruction

• Attempt to milk back cheesy precipitants, if the tube is pliant
• Gentle back-and-forth flushing with saline: be patient, continue pumping back and forth (even if you feel no forward flow or change) for a few minutes -- this will often dislodge just enough residue to allow for a proper flush
• Use guidewire or small stylet in proximal tube
  • Do not attempt to clear subcutaneous portion of tube with guidewire or stylet 2/2 to risk of puncture of tube, injure the pt, or create a tube leak.
• Use fogarty catheter to clear obstruction
  • Use a No 4 embolectemy cath for a 10-12F tube or a No 5 embolectemy cath for a 14F tube
  • Insert until obstruction met, then inflate and deflate and then continue insertion. Stop insertion just proximal to internal opening of feeding tube. Inflate and deflate while withdrawing catheter. Repeat as necessary.
  • Do not withdraw with balloon inflated because the tube and catheter will move together as a unit.
  • Confirm position/integrity of tube with contrast radiography after procedure
• Flush with pancreatic enzymes and allow 30-60 minutes to dissolve obstruction.
• Attempt to flush with water
  • The smaller the syringe used, the greater the force that can be applied (pascal's principle)
    • Catheters are prone to aneurysm and rupture (especially Broviaks) therefore, always confirm tube integrity with contrast radiography if this method is used.
  • coca-cola has not been shown to be superior to water and may result in precipitants and further blockage
• Use commercially available declogger (Bionix)

Complications

• Catheter perforation, aneurysm, or displacement
• Internal catheter leak
• Stomach perforation

References

• Roberts: Clinical Procedures in EM, 5th ed.