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

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. The longer the tube is blocked, the harder it may be to unblock. If you delay unblocking your child’s tube, this may prevent your child from receiving feeds, fluids or medications.

How do you know if a feeding tube is blocked?

If your child receives a feed continuously via the feeding pump, 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.

If your child receives a gravity feed using a feeding bag, the feed will stop dripping in the dripping chamber of the feeding bag system.

When you are flushing your child’s tube, it may feel hard to push. If only a small amount of fluid will go into the tube, this is called a "partial blockage".

If you cannot get any fluid into the tube, this is called a complete blockage.

If your child’s G or GJ tube has an adaptor at the end of their tube, remove and flush it with water to clear the inside of the adaptor of any possible blockage. If you remove the adaptor and stomach contents flow back out of your child’s G or GJ tube, your child’s tube is not blocked. Rather, the adaptor was blocked and it can be washed or replaced. If stomach contents do not flow out of the G tube or GJ tube after removing the 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 a 5 mL slip-tip syringe and warm water.

1. Fill the 1 mL and 5 mL slip-tip syringes with warm water.
2. If your child’s tube has an adaptor attached to the end of the tube, remove it.
3. Connect the 1 mL syringe directly to the feeding tube.
4. Using a pulsating push-and-pull motion, insert as much water into the tube as possible. This pulsating 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 warm water, or the amount recommended by your child's health-care team.
6. If you removed the adaptor to attach the 1 mL syringe directly to the tube, re-attach it to the tube to continue giving feeds, fluids and medications.

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. You will need a prescription from your child's health-care provider to get the pancreatic enzymes from a pharmacy. Your G tube specialist may provide you a prescription as well.

When using the pancreatic enzymes, please consider the following:

1. Pancrelipase is made from pork products. Cultural, personal and dietary considerations must be considered.
2. The combination of medications cannot be used for children receiving a ketogenic diet.
3. If your child has an allergy to pork products, do not use pancreatic enzymes.
4. Pancreatic enzymes can be irritating and cause redness to the skin. Use gloves when handling the pancreatic enzyme capsule. If the enzymes comes into contact with your skin, 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).

Follow these instructions:

1. Wash your hands and then put on a pair of gloves.
2. Open the pancreatic enzyme capsule. Pour the powder contents into a medication cup. Discard the outer capsule.
3. Crush the sodium bicarbonate tablet until it is a powder. Add it to pancreatic powder in the medication cup.
4. Add 5-10 mL of warm sterile or distilled water and mix the solution in the medication cup.
5. Draw up the solution into the 5 mL syringe. Push as much of the solution into the tube as possible. Be careful not to get it into your eyes or your child’s eyes.
6. Let the solution sit in the tube for 30 minutes.
7. Attempt to flush the tube with at least 5 mL of sterile or distilled water, or the amount recommended by your health-care team.
• If your child is younger than one year, only try this procedure once.
• If your child is older than one year, you can repeat the procedure twice. If you are unsuccessful in unblocking the tube, you may repeat this procedure immediately after the first attempt. Try to remove the first dose of the pancreatic enzyme solution from your child’s tube before pushing the second dose. If you cannot remove the first dose, proceed with the second dose.
8. If the tube has become unblocked, flush with at least 5 mL of sterile or distilled water (or the amount recommended to you) and continue with your feeds and medications.

If warm water or activated pancreatic enzymes do not unblock the feeding tube, contact your child’s G tube specialist to have your child’s tube replaced in hospital. If your child has a blocked low-profile tube or any balloon type tube, see below.

If your child’s low-profile tube is blocked

Low-profile balloon type G tubes, such as the Mic-Key button or AMT MiniONE, rarely block because they are much shorter than other types of G tubes. Make sure the extension tubing is not blocked by flushing it with 5 to 10 mL of warm sterile water, or the amount recommended by your health-care team. If the extension tubing is blocked, replace it with new extension tubing. If you have been trained to change your child’s low-profile balloon type G tube, you may replace the feeding tube with a new one.

Foley catheter

To unblock your child's low-profile G tube, do the following.

1. Wash your hands with soap and water.
2. Use a slip tip syringe to deflate the balloon of the 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 water to attempt to remove the blockage, or the amount recommended to you.
5. If you successfully unblock the low-profile G tube, and the tube is not broken, wash the low-profile G tube with soap and water, rinse it, and lubricate the tip of the low-profile G tube. Re-insert it back into the stoma. Once inserted, inflate the balloon with the amount of sterile or distilled water you normally use.
6. Confirm that the tube is in the stomach by checking the pH of the stomach contents. A pH of 6.0 or less means the tube is correctly in the stomach. To learn how to check the pH, please see the article "How to change the balloon G tube and check tube placement".
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.

If your child’s low-profile GJ or combination tube is blocked

If your child has a low profile GJ or combination tube that you cannot unblock, contact your G tube specialist to arrange for it to be replaced. You may need to go to the emergency department if it is after hours or during weekends or holidays.

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 tube and feeding bag system as clean as possible.

• Flush the tube with at least 5 to 10 mL of water before and after each tube feed and medication dose, and every four hours during continuous feeds. To ensure this flush volume is safe for your child, discuss with your child's health-care team.
• 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 bolus feed. You may use hot water and soap or a water and vinegar mixture to clean the tubing.
• Dissolve all medications completely before giving them through the G tube or GJ tube.
• Work with the pharmacy team to choose the best form of medications for use with a G tube or GJ tube.

At SickKids

If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.

G Tube Resource Nurse contact info:

Phone 416-813-7177

g.tubenurse@sickkids.ca

On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.