Management of Blocked PEG Tubes in Patients Receiving Duodopa Gel
Immediate Management Options
- Direct replacement through the existing tract should be attempted before the tract closes completely in patients with mature stoma tracts (>4 weeks old) 1
- Replacement should be executed expeditiously to maintain patency and prevent closure of the tract in patients with mature stoma tracts (>4 weeks old) 1
- Balloon-type replacement tubes are most commonly used for blind replacement in patients with blocked PEG tubes 1
- A balloon-tipped Foley catheter of the same size can be used temporarily to keep the tract open if no commercially available gastrostomy tube with similar diameter is available for immediate replacement 2, 1
- This temporary solution allows for administration of enteral nutrition, fluids, or medications until proper replacement can be performed in patients with blocked PEG tubes 2
Alternative Placement Options
- Percutaneous radiological gastrostomy (PRG) can be used as an alternative technique if endoscopic tube placement cannot be performed in patients with blocked PEG tubes 1, 3
- PRG is effective for long-term enteral nutrition support, but has higher rates of tube dislodgement compared to PEG 3, 4
Verification of Tube Placement
- After blind replacement, proper positioning must be confirmed before use in patients with blocked PEG tubes 2
- Verification methods include pH confirmation of gastric content (pH 5 or less) 2
- Irrigation of the tube with 3-50 ml sterile water without resistance or leakage can be used to verify tube placement 2
- Assessment of external length of the tube can be used to verify tube placement 2
- Water-soluble contrast study can be used to confirm position of the tube 1
Prevention of Future Blockages
- Routine water flushing after feedings can prevent tube occlusion in patients with PEG tubes 6
- Simple water flushing should be the first attempt to regain patency if the tube becomes clogged 6
- For persistent obstruction, a guide wire or commercially available tube declogger can be used by an expert in case of PEG tubes 6, 7
Caution
- Infusion with cola-containing carbonated drinks or pancreatic enzymes to unclog tubes is not recommended due to the risk of tube contamination with bacteria 7, 4
- The use of 8.4% w/v sodium bicarbonate solution to unblock tubes is not evidence-based 7, 4
- Home-made blenderized admixtures should not be utilized as they are less safe and effective than commercial enteral nutrition formulas 7