June 18, 2010

Clogging the tube. Oops. Now what?

Clogging a tube for the first time is a scary thing, especially when it isn't yours.  Clogging your own somehow just feels like you've been stupid, but that surely you'll work it out.

If you've yet to do it, let me please say to you - don't sweat it, it happens to everyone, and there's always a solution.  Ever since we've invented dynamite, anyway.



Broadly speaking, there are two ways to unclog a tube/extension/button/syringe tip (I'm just saying "tube" for ease here): Mechanical (using a device) or solvent (dissolving the clog).

First, it's time to BUST A MYTH.

The thing is, we all want Coke to do everything.  To be The Real Thing.  We know it can clean copper coins,  remove oil stains from garage floors, and so on and so forth, so it makes sense that it would be the absolute bees knees for a safe, 'foodie' way to dissolve a clog.  Except, there is absolutely no evidence, statistical or even anecdotal, to suggest that Coke or any other carbonated beverage is any more effective then warm water.  They don't call H2O the Universal Solvent for nothing, folks.  And none of the science related to Coke's acidic abilities suggests that it will be effective in the tube situation either.  Acid is not necessarily what you need anyway.  Sorry, Coke, you're fired.

But if you really must use Coke, or another soda, only use a teeny bit and be prepared for the gas response, yes?  Also be prepared for stickiness, for quite possible failure, and for having to use water afterwards anyway.

So....

1) Solvents.

This is usually the first and best option.  Water, preferably warm, but for the first try the temperature doesn't matter too much.  The trick is to bring the water in contact with the clog, so it makes sense just to fill the whole apparatus with water and have a syringe and plunger at the end. So first try...

Technique #1: Pull-and-push.
Thinking about how the clog got there, ie down the tube from the outside in, it makes sense that it will move more easily in reverse than by pushing down harder.  Now you've got your liquid in there and your syringe attached, give a very gentle push on the plunger to make sure everything is in contact; now pull back gently.  If you feel it has 'let go' now, then plunge inwards gently and chances are the clog and everything will flow freely through.  Or, (and if the clog immediately recurs) repeat the pull-and-push action a few times until you feel some movement or 'release' in there.  If it seems the cloggy culprit is something solid and relatively insoluble like a hard seed or a flake of grape skin wadded up then it's best to just keep drawing it right up into the syringe and disposing of it.  If you used cold water and it didn't work, repeat with warm water.

NOTE for button-type users. If pull-and-push hasn't worked while in situ, and you have one of those balloon-type retainers, you may wish to pop the button out now and try it with a syringe while it's out.  With many buttons you can plug the syringe into the internal end of the tube and try that way.

If this hasn't worked for you, we'll need to move on to the next thing.  If you know for sure that your clog is solid and insoluble and the pull-and-push didn't work for you then skip the next bit and go to the following one.

Technique #2:  Make a cup of tea and have a sit down.
Really, although the tea isn't strictly necessary.  This technique involves the magical powers of time.  Using whatever is most appropriate for your equipment, simply 'soak' the clog with warm water.  As an example, just fill the tube with the water, clamp or stopper it, arrange so that the water stays down next to where the clog seems to be (eg in my case ensure my G tube end is elevated), and wait.  like, half an hour or so.  Be patient, things can take time.  When you unclamp/uncork, if the clog doesn't just suddenly drain away, go back to Technique #1 for a little pull-and-push action and see what happens.

Still no action?  Golly, well, not to fear, there are more tricks in the arsenal.

Technique #3:  Supercharged version of Technique #2.
No, you're not going to be drinking the tea really fast this time, but we are going to change the solvent.  This is where you can try your Coke if you still have faith.  It might work this time, who knows?  But there are other, better things.

What we're aiming for now is to digest the clog, so use something enzymatic.  Sounds odd, but meat tenderiser seems to be the number one choice out there.  Makes sense to me, especially if you're feeding meat.  Think of (or remember) thoselittle stringy bits that get stuck between your teeth every now and then when you eat meat?  And how hard they can be to dislodge?  So use the kryptonite (um, not literally kryptonite, please). Here are the things I've heard to work:

Meat tenderiser
Papaya juice
Pineapple juice
Proprietary digestive enzyme products.

Simply perform Technique #2 with one of these, and wait an hour this time.


OK, so if none of these have worked, or if you knew the whole time that it was a solid and insoluble blockage, it's time to move on to....



2)  Device Solutions.

Basically, using something to physically push the clog through.  Use common sense here, please.  No coathangers, no twigs you find lying around (just because I did that does not make it right), and nothing that might harm the tube, or worse, the human.

Many button devices have little locking ends and almost all have one-way valves to keep the stomach contents in.  So be careful with them.  My favourite device is the lacquered chopstick, which is simple to poke in, smooth, easy enough to clean appropriately before and after, and also handily tapered so you can't accidentally put it in too far.

If you've taken the button out, fine, you can be a little more cavalier in your approach but do remember if you're sticking something in a button still in place;   not too far, OK?

I have heard you can get special tube cleaning brushes now, made for extension sets and the like, and if someone can point me in that direction I'll link them up here.  I've heard of ordinary pipe cleaners being used, insulated electrical wire (thin stuff, and only on removed tubes naturally) and a whole bunch of stuff (like my twig) that I'm not even going to repeat.

Yes, but you know, what if.......

If none of this works, there's a very good chance something is wrong with the tube.  Technique #1 will work 95% of the time anyway with a little patience.  If there is seemingly something wrong, dynamite is not a good idea, and you should probably get to some medical attention pretty sharpish.  It might be time for replacement.

That's it for now, but I want to hear all your tips, stories, experiences and questions, so load up down there where it say "Comments", yes?  I'll post up links and cross-reference as more info comes to light.

Lastly, remember this is not rocket surgery.  It's just a tube.  We invented it, we clogged it, we can fix it.  You'll see.
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7 comments:

  1. I have used a tube de-cloger several times with success.

    http://www.mountainside-medical.com/products/Enteral-Feeding-Tube-DeClogger.html

    Mark

    ReplyDelete
  2. I used a pair of long skinny tweezers to get the googly eye(also called wiggle eyes) out of my son's PEG tube. Why was there a wiggly eye in his tube to start with? Your guess is as good as mine. He is 11 months old, so we are guessing that it's the tube fed version of a baby sticking everything in his mouth.

    ReplyDelete
  3. My daughter has a PEG-J and we use a tiny pinch of Bicarbonate of Soda in warm water, let it sit in the tube for about an hour and then pull and push a few times. It works every time.

    ReplyDelete
  4. This is the link for the long narrow brushes to clean the tube

    www.justmanbrush.com


    Item Number: 710250
    Narrow Tube BrushesStraight Tip
    Brush Material: White Nylon
    Brush Diameter Inches: 3/16"
    Brush Length Inches: 2 1/2"
    Overall Length Inches: 13 1/4"
    Quantity: 5
    Price: $1.67

    ReplyDelete
  5. Fantastic feedback everyone, thanks! i searched out Nancy's link a bit closer and here's the direct page:
    http://www.justmanbrush.com/catalog/plugins/lineitems/browse.asp

    Keep 'em coming! I'll edit and update soon.

    ReplyDelete
  6. I just bought Dr. Browns Baby bottle cleaners. Four for $6 and they work great. They are very tiny with a brush on the end. I got it at toys are us. I have also used coke and the plunger method.

    ReplyDelete
  7. Here are two more I found:

    Clog Zapper(Wheeling, IL; 800-323-6305)
    and

    InTRO-ReDUCER, a product made by Health Improvement Associates (Freeland, MI; 800-526-6364).

    Bionix
    Enteral Feeding Tube DeClogg

    ReplyDelete