Block Buster

‘Underlying Growth’ by Kathryn Lean

Robyn Wortel is clever about clogs. Here, the clinical education and training manager for world-leading medical device company, Avanos, shares her tips for avoiding gastrostomy feeding-tube blockages and what to do when they happen (spoiler alert: Coca-Cola is never the answer).

Don’t rush to crush

What’s the most common cause of gastrostomy feeding-tube clogs? Incorrectly prepared and delivered medication. That’s really the biggest issue. There are a lot of medications that are difficult to transition from an oral form to a liquid form and maintain appropriate dosage – and this is where your pharmacist needs to become your best friend.

If you do crush medications, crush them to a fine powder, disperse the powder in room-temperature water and deliver into the feeding tube – and please don’t mix medications. There are pill crushing devices available from pharmacies and healthcare providers. There’s also a fabulous resource called Don’t Rush to Crush, which every pharmacist should have access to.

Some medications have what they call an ‘enteric coating’, and that enteric coating is intended to keep the drug intact until it transitions through the stomach. If you’ve got medication that needs to be absorbed further down in the gut, your pharmacist and health care team will guide you.

Flush, flush, flush

Another cause of feeding-tube blocks is not flushing properly – and also not leaving time between delivering medication, flushing, and starting feeding again. What happens inside the stomach is different to what happens outside the stomach. And when you’ve got a combination of food and medication in a very small, confined space like a feeding tube or extension set, chances are they’re not going to get on terribly well together.

Make sure you flush with at least 15ml of water before, after and between each medication and once you’ve finished administering your meds. For nocturnal or continuous feeds you want to be routinely flushing your tubes with at least 30ml of water – and for bolus feeds, flush at least 60ml of water before and after meals.

When you’ve got a clog…

First of all, never use Coca-Cola or fruit juices when you’re trying to shift a feeding-tube blockage as these liquids can actually cause clogs or create adverse reactions. I would always start with room temperature water and the sooner you can get on to it, the better. Using a wide syringe – ideally 30mls or bigger – you want to start a gentle pumping action with the water. Pushing it in, pulling it out, pushing it in, pulling it out, to see if that shifts the block.

Sometimes you need to push the water into your tube and let it sit for a bit – up to 20 minutes – and then come back and start the pumping. A smaller syringe will, of course, give you greater pressure, but you’re then more likely to damage the tube. Our recommendations have always been to use a 20-30ml syringe so you even out the pressure. You want to shift the clog, not burst the tube.

If medication is the reason for your blockage, you’ll probably find that only water is going to unblock it. There are enzymatic clog dissolvers, like Avanos’ CLOG ZAPPER*, that can work on protein-based clogs, like those caused by formula and blenderised feeds.

If you can’t shift the clog…

What’s your back-up plan if your gastrostomy tube is blocked and you can’t unblock it? Everyone should have a spare feeding tube so you can replace it yourself if you’ve been trained to do so, or rock back up to your healthcare professional, hospital or your doctor so they can change it with as little interruption to your daily life as possible.

It’s traumatic when you can’t feed or medicate, so it’s a huge relief when you successfully unblock or replace a tube and then realise why it was blocked in the first place – and know how to avoid that happening again.

The literature tells us that there’s up to a 45 per cent chance a feeding-tube will block over its lifetime so, if yours does get clogged, you’re certainly not alone. Everybody has to make a couple of mistakes along the way and it’s okay to make those mistakes. But know what caused the mistake, rectify it so it doesn’t happen again, and share that information. Proper information, well shared, is invaluable.

This article was made in partnership with Avanos. For easily digestible information about tube-feeding at any age and any stage, visit TubeFed by Avanos.