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Thursday, August 7, 2014

Clogged feeding tube

This post should make anyone who has ever felt dumb for making a mistake with their tube fed kiddo feel better. **Disclaimer: If the feeding tube you are in charge of caring for ever gets clogged, talk to your doctor about how to unclog it!**

Our day started out pretty good yesterday. We got the big kids off on the school bus and then I got Raya all dolled up and ready to go to school. She is LOVING that she doesn't have to take her feeding pump to school and went on and on about how much she loves just wearing 1 backpack.

As soon as she got home from school, her respite provider came and I got her pump ready and her midday doses of meds and her probiotics. I had a whole list of things I needed to do while her respite provider was here, so I plugged her in to the pump and started her feed and then I went to flush her G port so I could do her probiotics. When I was connecting the G extension, I noticed a fleck of something bright orange in the stem of the GJ tube. Pretty sure it was carrot that worked its way in there when we were venting/draining her stomach overnight. It was a little bit stuck but I pushed & pulled with the syringe and got it to go through into her stomach. The tube was clear (or so I thought) and so I got the syringe with the probiotics and started to push it in. I had opened the capsule, dumped the probiotic powder into a cup with about 10ml of warm water, let it sit for about 15 minutes to dissolve, and then stirred it until there were no clumps left. Then I drew it up into the syringe, shook it again, and started to push it. This is the same way I've been doing it the entire time she's had the GJ tube (almost a month this time around) and the same way I did it when she had a GJ tube when she was younger.

Right as I started to push the syringe plunger, Raya moved or did something (I don't remember what) and I stopped pushing the plunger for about 2 seconds and reached to grab something off the counter. When I started pushing the plunger again, it moved a little bit and then just stopped. I pulled back on the plunger and nothing happened. I pushed again and nothing happened. I pushed a little harder and the med port popped open and sprayed probiotics all over both of us. The G port of her GJ tube was clogged. Not just a little clogged, but completely and totally 100% blocked by a combination of undigested carrot that I thought had been flushed completely out and probiotics. It felt like I was pushing against a brick wall. I may have had some swear words in my head at that point.

I did all the things we tell people to do on the Feeding Tube Awareness facebook page when they're dealing with clogged tubes. First, I got a 60ml syringe with about 10ml of very warm water. (because it's summer in Phoenix and that's the only kind we have right now) I tried to draw back on the syringe and nothing came out, so the plunger just got sucked back in when I let go. I pushed, but nothing budged. Well, actually, water did spray out of the closed med port that I was holding shut with my finger. I thought maybe a smaller syringe would help so I tried the same thing with a smaller one. It didn't help.

Since warm water hadn't helped, I switched to a single port extension tube and tried the pushing & pulling with an empty 60ml syringe. For reference, the extension tubes I was using were the clear Y port and the single/straight port in this picture:

That didn't help either. When I tried pushing warm water with the 60ml syringe again, the water actually squirted back at me from around the tip of the syringe that was firmly pushed into the extension. At that point, I decided I'd better call the GI nurse. {GJ tubes can only be changed by a radiologist under fluoroscopy, which is why a clogged GJ tube is a very bad thing} I left a voice mail about the clogged GJ, which I was pretty well convinced we'd have to change, and the school paperwork that I needed signed by the GI doctor. She called me back a few minutes later and asked me what I had tried. I told her what I'd already done. She suggested putting Coke or Sprite in, and I told her I would try it but that I knew there was very little likelihood of that helping since I couldn't get ANYTHING to go in or out, not even a little bit. I asked if they had ever used or heard of Clog Zapper (made by Corpak for the purpose of unclogging clogged tubes to avoid having to change them) and she said she'd never heard of it, and neither had the other nurse. She said she would have to call Interventional Radiology (IR) and ask them what else I could try because they're rather possessive of the GJ tubes and don't really like to have any other departments messing with them. (understandably so; that would be like spanking somebody else's kid, I suppose)

She called me after she had talked to IR and said they had told her to have me try using a 1ml syringe and "push really hard" because the pressure from the smaller syringes can be more effective than larger syringes. I tried that and it was a total joke. It did NOTHING. I drew the plunger all the way back, pushed the syringe into the extension tube (it fits directly into the single port extension) and pushed really hard. All that happened was that when I let go of the plunger, it popped back out. I pushed it as fast & hard as I could and it didn't feel like it was doing anything at all. After a few more minutes of working on it with different sizes of syringes, with and without warm water, I decided we were not getting anywhere and that it was going to have to be changed anyway, so I did something that we always warn people on FTA not to do because there is a good possibility of damaging the tube. (so I am absolutely NOT suggesting this to anyone) Since she has had an AMT Mini One for 2 1/2 years now, we have a lot of those little blue introducers that come in the kit. I thought maybe that would help push through the blockage, so I put it into the G port on the GJ. Maybe if it had been another 2-3 inches longer, it would have helped. If it had just been the little bit of carrot that I'd had to clear out earlier, it would have helped, but it wasn't and it didn't. At that point, I gave up and called the nurse back to tell her to go ahead and put in the order for a tube change. It was very frustrating because if it had been a regular G tube, I could have cleared the clog even if it meant taking out the tube, clearing it, and putting it back in. (which I am also absolutely NOT suggesting to anyone else) Being a GJ though, there was very little else I could do that I hadn't already done.

While I waited for a call from the IR scheduler, I decided I had nothing to lose by continuing to try things since the only alternative was to change the tube anyway. I texted a few friends that live close by and found somebody that had Coke that I could try. It was comical showing up on my neighbor's front porch with a little cup and asking her 12 year old daughter for some Coke. The confused look on her face was precious. :) I took the cup of Coke home and sucked some up into a 60ml syringe. I connected it to the extension, wrapped a washcloth around it in case it popped out or leaked, and pushed. Since the stem on Raya's tube is a little on the long side, I could actually see the Coke not being able to go into the tube at all. I pulled back on the plunger, hoping that it would somehow end up sucking some of the Coke into the tube, but it didn't. I gave up on that and drank the rest of the Coke. I decided to try air again. When I pushed really hard on the syringe, I could actually see the silicone expanding as the tube got filled with air. That was slightly disturbing but made me feel like the tube was beyond saving and that I had done the best I could.

On a whim, and probably also by divine inspiration, I decided to try one last thing. I got the 3ml syringe out again (my favorite syringe size), pulled the plunger all the way back, pushed it into the extension tube, and pushed in the plunger as hard as I could. It didn't do anything productive and just popped back out. I thought that maybe a bit of sustained, constant pressure on the blockage would help, so I pushed the plunger all the way in and taped it so it couldn't pop back out.

I left it like that and let Raya play with her respite provider while I tried to get some things done. When IR still hadn't called me 30-45 minutes later, I decided to check on the syringe. I took off the tape, expecting the plunger to pop back out but it only came out about 1/3 of the way, and it was much more slowly than it had before. I spent another 10 minutes pushing & pulling with syringes, with and without water. After a few minutes, I could tell that I was making a tiny bit of progress at breaking through the clog. It got to where I could feel that a tiny bit of water was going through, so I pushed hard with a 60ml syringe that had about 10ml of water in it, and it FINALLY popped through the clog! It almost made Raya vomit, but it cleared! I let her hold a puke bag while I got some warm water and slowly flushed the G port really well to make sure the clog was completely cleared. I also did a happy dance and said a prayer of thanks for the inspiration to be patient, keep working at it, and to try taping the syringe plunger in.

I called the nurse back and told her I had gotten it cleared by putting the 3ml syringe in the extension and taping the plunger in. Her response was, "Oh, that was smart!" Yes, yes it was, thankyouverymuch. She was happy to call IR back and cancel the change order, and I was happy to not have to show my face in IR and know that they were probably referring to me behind closed doors as the mom that clogged her kid's tube and talking about how dumb I must be to have done that. (and they probably wouldn't have, but yeah, they probably would have)  Most importantly though, I was really happy to not have to put Raya under anesthesia again in such a short time frame. I need to go back and count how many times she's been put under. It's more than the average person will be in a lifetime though, I'm sure.

SO. That is how we cleared the rock-solid, unclearable clog from Raya's GJ tube. It took up my entire afternoon and I didn't get anything else done that I needed to. I did, however, celebrate my victory by changing out of my spit-up-crusted, Coke-spattered, probiotic-spattered shirt that I'm pretty sure I had slept in the night before and put on my new and very awesome shirt:

Because let me tell you, unclogging a very clogged GJ tube, narrowly avoiding a trip to the hospital and anesthesia, and not letting myself feel like total crap for accidentally clogging the tube in the first place made me feel like Wonder Woman.

The moral of this story is this. EVERYBODY makes mistakes. Freak tube clogging accidents and other feeding tube-related accidents happen to everyone, even people who have been doing this stuff for 4 1/2 years and spend many, many hours a week answering other people's tube feeding questions & helping them troubleshoot when things go wrong. Forgive yourself, learn from it, and move on!

3 weeks later, we are dealing with a sluggish, partially clogged J port that has been giving us trouble for a week. It is not clogged in the same way that the G port was clogged, so this would not have helped us with the G port problem we had, but it has made a huge difference with the clogged J port. This time, I have been able to push meds & water through and we've been able to feed through it, but it is really difficult at first, and I've had to flush it every couple of hours or else it clogs again. We've had a lot of pump alarms that were the result of the port being clogged. What the nurse suggested to me that actually helped was using seltzer water (in the alcohol aisle at Walmart for about 65 cents per 1-liter bottle) and pulsing it through with a 3ml syringe. I've had to use a single port extension because the med port will pop open if I try to use a Y port extension. We are now using seltzer water for all of the flushes to keep the tube open until we either clear it all the way out or have to change it. Just note that seltzer water is JUST carbonated water with no other ingredients, like sweeteners or sodium. Not tonic water or club soda, just seltzer water.

1 comment:

  1. We were told in the hospital to save the blue "golf tees" (as the doctor called them) to use in case of a clog in the g tube. Didn't realize that could damage the tube!


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