gj tube continually blocking

Pediatric Critical Care Columnist · Jan 21, 2008

Is there a chance the tube is kinking in his jejeunum? What is being put through the tube? Some meds are very difficult to push through a small bore tube either because of particulate matter or because they're really viscous. All meds given GJ or NJ need to be diluted prior to administration and flushed VERY well after. Chloral hydrate and sodium chloride supplements are two meds that precipitate when mixed; if they're given close together without a really good H2O flush after each, the tube is toast. This is a problem even when the NaCl is mixed in with the feeds, so flush, flush, flush! Some feeding formulas are worse than others for clogging tubes. Peptamen and Jevity are two notorious ones. Perhaps he needs some free water mixed into his feeds. If I think of anything else I'll be back.

mellie35 · Jan 23, 2008

well he is on nutramagen 24k cal for 18 hrs a day and all meds are given through the gtube. (pepcid, reglan and bactrim) they thought the first tube could have been kinked but they tried another one and the same thing happened, the plan now is to do the fundo surgery on him and feed him through a g tube. the last tube he had before all of the problems started was fine, he had it for 2 months without any blockage so idk. i just feel bad cause now he is starting with seizures and the mom is a wreck. her sisters baby was 1 and a half and went into a coma after a grand mall and died. so im just praying. thanks so much for your input. i appreciate it.:>

Pediatric Critical Care Columnist · Jan 23, 2008

Nutramigen 24 isn't especially viscous, so I doubt if it's that. My money is on either mechanical obstruction somewhere along the j-tube, or from med administration. Have any of his meds changed since this all started? It could be something as simple as inadequate flushing after his meds. Too bad they couldn't solve the problem without resorting to surgery. Fundos aren't the be-all or the end-all for reflux prevention. Many times they fail. The new onset seizures are worrisome too. Poor baby. Poor mom.

mellie35 · Jan 23, 2008

well hes had 2 seperate tubes placed since being in the hospital and both got blocked. i am his homecare nurse and there are 2 of us on this case and we never had a problem with blockage b4 these new tubes.he actually went to the hospital to get a new tube placed d/t the original tube having a pin sized hole in it. so idk if it couldve been a manufacturing defect in these tubes?? but we kept it flushed very well knowing that the j-port will block easily if not flushed and no prob's.im just hoping he doesnt have to go through much more. his seizures are like a startle reflex on a newborn but they are unprovoked. they happen randomly during the day and can happen from q 15 seconds to one q hour? his pediatrician told us they werent seizures and so did another on call pediatrician in the er, so mom was happy, and then they did an eeg and found out they are. im going to see him tomorrow, i miss his little face! he was delayed and just starting to smile and interact nicely. well thanks again janfrn:)

Pediatric Critical Care Columnist · Jan 23, 2008

mellie35, you would be astounded at the number of peds nurses in hospitals who have NO clue how to care for medically complex kids like your little friend. So many of them have never seen a jejeunostomy tube and don't realize that that internal diameter is only about 2 mm. Even in the unit where I work and nearly every patient has an NJ (mostly 6Fr), there are people who still think that they can put a thick oral liquid like Tylenol into an NJ (it should be a clue that you have to use about 100 foot-pounds of pressure to get Tylenol into these tubes!) and then let the feed (which is often Peptamen!) push it into the gut. Flush? Why? The usual tube deblocking tricks like using Coca Cola or Cotazyme will only work if the blockage is caused by feed... not meds, and how do we know what's caused the blockage? We don't.

Those seizures sound like infantile spasms. I hope he's getting adequate anticonvulsant treatment. He's lucky to have dedicated and loving home care nurses like you. I hope you enjoy your visit; I know he will!

mellie35 · Jan 24, 2008

hi. just wanted to thank you again for your input. i saw him today and he is such an angel. he hardly ever cries even though hes been through so much. i guess the blockage couldve been due to not flushing, but you would think that since they know thats why he was there, they would keep it flushed very well. neway as far as his seizure activity, i asked the nurse if they had started him on nething since the eeg and she said no, so idk what they are waiting for. during my visit he did it quite a few times. she was going to ask the dr about it. mom wasnt there so i was only able to get limited information. i appreciate your responses. its so good to talk to someone with alot of experience.he is scheduled for the fundo on friday and then we'll see. ill keep ya posted.

Pediatric Critical Care Columnist · Jan 24, 2008

Please do. I'm mom to a medically complex former child and have more than a passing interest in how others are cared for (or not, as the case may be). I hope they decide what to do about these abnormal movements of his and that the fundo helps.

mellie35 · Feb 6, 2008

Please do. I'm mom to a medically complex former child and have more than a passing interest in how others are cared for (or not, as the case may be). I hope they decide what to do about these abnormal movements of his and that the fundo helps.

hi just wanted to let ya know he had his fundo surgery and is now being fed throught the g-tube. he is home for 1 day now and seems to be doing good. his feeding was changed to bolus and he seems ok with it except for a little bit of gagging at the end of the feeding. i think maybe a little too much for him. hes getting 225 ml over an hour and a half which is an increase from his usual 52 ml and hour. neway he has started on bottle feeds 10 ml at a time and seems to really enjoy that. as far as his seizures, they started him on phenobarb and i have noticed a small decrease in them, but its only been a wk so i know it could take 2-3 wks for the full affect.

Pediatric Critical Care Columnist · Feb 7, 2008

I'm glad your little fellow did well with the surgery. Maybe they could adjust the caloric content of his feeds so he could have smaller volumes if the 225 mL seems to be making him gag. Seizures are such tricky things to keep on top of; phenobarb is such an old-school drug, but it works for so many kids I often wonder why they don't try it first. Of course it's important to keep eyes on the levels, because the difference between therapeutic and toxic isn't very large... Now that he's back home you should be seeing a lot more of him, eh? Enjoy!