G/GJ tubes: What to do if your child’s feeding tube is blocked

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If your child has a G or GJ tube, and it becomes blocked by formula or medications, it is important to try to unblock the tube as soon as possible. Leaving the tube blocked will delay or prevent food (i.e., formula), liquid, and medications from entering the body. The longer the tube remains blocked, the harder it will be to unblock.

How do you know if a feeding tube is blocked?

  • The feeding pump may beep, saying there is an occlusion or flow error. This may be a problem with the pump, the feeding bag, or the tube itself.
  • When you are flushing your child’s tube, it may feel hard to push and only a small amount of fluid will go into the tube. This is a called a “partial blockage.”
  • When you are flushing your child’s tube, you may not be able to get any fluid at all into the tube. This usually means the tube is completely blocked.

If your child has a red adaptor at the end of their G tube or GJ tube, remove it to see if this is the cause of the blockage. If you remove the red adaptor and stomach contents flow back from the tube, your tube is not truly blocked. Rather, the red adaptor was blocked—it can be washed or replaced. However, if the G tube or GJ tube does not flow back after removing the red adaptor, this means the tube is blocked.

How to unblock a feeding tube

There are two different ways to unblock a feeding tube at home. Try using warm water first. If that doesn’t work, you can use activated pancreatic enzymes.

Using warm water

To unblock your child’s G tube or GJ tube, you will need a 1 mL and 5 mL slip-tip syringe and warm sterile or distilled water.

  1. Fill the 1 mL and 5 mL slip-tip syringes with warm sterile or distilled water.
  2. If your child’s tube has a red adaptor, remove it.
  3. Connect the 1 mL syringe directly to the feeding tube.
  4. Using a pulsing push-and-pull motion, insert as much water into the tube as possible. This thrusting motion will help clear out any formula or medication that has built up inside the tube. You may have to try this a few times to unblock the tube.
  5. When the tube is no longer blocked, flush with at least 5 mL of sterile or distilled water.
  6. Remove the syringe from the end of the tube, then replace the red adaptor or use the plug connected to the end of the tube.

Using activated pancreatic enzymes

If you cannot unblock the feeding tube with warm water, you can try using pancrelipase (a combination of pancreatic enzymes) and sodium bicarbonate. This mixture works very well when the tube becomes blocked with formula.

When using the pancreatic enzymes, please consider the following:

  1. Pancrelipase is made from pork products. Cultural and dietary considerations must be considered.
  2. If your child has an allergy to pork products, do not attempt this.
  3. There is a possibility of skin irritation and redness if the pancreatic enzymes are left on the skin. When opening the capsule, be careful not to spill the contents on the skin. If you do, simply wash the area with soap and water right away.

To use the pancreatic enzymes, you will need one pancrelipase capsule, one sodium bicarbonate 325 mg tablet, sterile or distilled water, and two 5 mL syringes (one to mix the medications and one to flush).

This is what you can do:

  1. Wash your hands.
  2. Open the pancreatic enzyme capsule.
  3. Crush the sodium bicarbonate tablet.
  4. Mix the two drugs together with 5 to 10 mL of warm sterile or distilled water.
  5. Push as much of the mixture into the tube as possible; then let it sit in the tube for 30 minutes.
  6. Attempt to flush the tube with at least 5 mL of sterile or distilled water.
    • If your child is younger than 1 year, only try this procedure once in one sitting.
    • If your child is older than 1 year, you can repeat the procedure twice in one sitting.
  7. If the tube has become unblocked, flush with at least 5 mL of sterile or distilled water and continue with your feeds and medications.

If warm water or activated pancreatic enzymes do not unblock the feeding tube, and if you have been trained to change your child’s G tube, you may replace the feeding tube with a new one. You cannot change a GJ tube at home.

If your child has a G tube or GJ tube that cannot be replaced by you at home, contact your G-tube specialist to have your child’s tube replaced in your hospital’s radiology department.

If your child’s low-profile tube is blocked

Low-profile G tubes​, such as the Mic-Key button, rarely block because they are much shorter than other G tubes. Ensure the extension tubing is not blocked by flushing it with 5 to 10 mL of warm sterile water. If the extension tubing is blocked, replace it with new extension tubing. You can also insert a slip-tip syringe directly into the feeding port of the tube to attempt to flush the tube; however, you cannot do this for all types of low-profile tubes. If these things do not work, you can try to manually unblock the tube. Here’s how:

  1. Wash your hands with soap and water.
  2. Use a slip tip syringe to deflate the balloon of tube. Throw this water away.
  3. Remove the tube from the stoma.
  4. You may see a physical blockage in the tube. Use your index finger and thumb to squeeze the tube at the site of the blockage. Flush the tube with at least 5 mL of sterile or distilled water to attempt to remove the blockage.
  5. If you are successful at unblocking the low-profile G tube, and the tube is not broken, wash the low-profile G tube with soap and water, lubricate the tip of the low-profile G tube and re-insert it into the stoma. Once inserted, inflate the balloon with the amount of sterile or distilled water you normally use.
  6. You will then need to check that the tube is in the right spot. Do this by attaching the extension tubing to the tube and pull back with a syringe until you see stomach contents flow from the tube. Once you see stomach contents, flush the tube with 5 mL of water.
  7. If you are unsuccessful at unblocking the low-profile tube, or the tube is broken, insert a new low-profile G tube or a Foley catheter. If you have inserted the Foley catheter, contact your G tube specialist to arrange for the low-profile tube to be replaced.

Preventing a blockage

The best way to prevent a feeding tube from getting blocked with formula or medication is by keeping the inside of the feeding equipment and feeding tube as clean as possible.

  • Flush the G tube or GJ tube with 5 to 10 mL of sterile or distilled water before and after every feeding.
  • Flush the G tube or GJ tube before and after every dose of medication.
  • Flush the G tube or GJ tube every four hours during continuous feeds.
  • Clean the feeding bag and all extension tubing after each feeding and each dose of medication. You may use hot water and soap or a water and vinegar mixture to clean the tubing.
  • Dissolve all medications completely before administering them through the G tube or GJ tube.
  • Work with your pharmacy team to choose the best form of medications for use with a G tube or GJ tube.

Key points

  • If your child’s tube becomes blocked, it is important to try to unblock the tube right away.
  • If your child’s tube has a red adaptor, remove it first to check if it is the cause of the blockage.
  • Use a pulsing push-and-pull motion with warm sterile or distilled water to try to unblock your child’s feeding tube. If this does not work, contact your G tube specialist.
  • If you have a prescription for pancreatic enzymes and sodium bicarbonate, try this method if warm water does not work.
  • If your child has a low-profile G tube, first try to flush the tube via the feeding port before removing the tube and unblocking it manually. If this does not work, change the low-profile tube or insert a Foley catheter.
  • Prevent tube blockage by flushing with 5 to 10 mL of sterile or distilled water before and after you give food or medication, and every four hours during continuous feeds.
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Holly Norgrove, RN, BScN

9/7/2015


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