Blocked enteral tube

Stepwise approach:

• Is the tube clamped or kinked, internally or externally?
• Can device move within tract? Consider buried bumper.
• Unblock with warm water
  • Use 60mL syringe to draw back, then clamp, creating negative pressure
  • Attach 20mL syringe full of warm water and unclamp - water will be drawn down tube, may need a little push too
  • Use a pull-push technique to agitate the water within the tube. If seeing sediment within syringe, keep discarding it until the aspirate is clear.
• Try flushing/locking with 10mL of Creon (pancrelipase) crushed with 650mg bicarbonate tablet, then mixed with warm water. Leave locked for three minutes then flush thoroughly with warm water again.
• Try an endoscopy cytology brush, a dedicated gastrostomy tube brush, or other commercial devices that create mechanical force through vibrating.
• Don't use guidewire/stylet, excessive force, or carbonated beverages