Another Clogged Peg Tube

Here I was just beginning to think that I had mastered the clogged peg tube, when lo and behold, it happened again.

Bob's peg tube hasn't clogged since, I don't know, last August? Since then, I've developed my own preventative routine which consists mainly of disconnecting his overnight pump immediately when it runs out, then immediately flushing Bob's tube with hot tap water. That, along with an occasional cleaning with Adolph's Meat Tenderizer, has kept his tube flowing. (For those interested, dissolve a small amount of meat tenderizer in a small amount of water, syringe just enough to fill the tube itself and let sit for about an hour before flushing it through with lots of water.) Before I figured this out, the doctors were telling me it was the crushed medications clogging his tube, but I realized it wasn't the medications but the Jevity (the canned liquid "food") that was causing his tube to clog. Jevity is thick and sticky and solidifies really fast. I'd been in the habit of turning off the pump and doing other things before disconnecting Bob's tube and flushing it. Big mistake. Though I didn't realize it at the time, I mean, how many times had I seen nurses in the hospital do the very same thing?

So I thought I was on top of it until the other day, when I disconnected Bob's pump and tried to flush it out with the hot water... and nothing. Nothing but a huge water balloon snake at the top of the tube growing fatter and fatter. Damn. So I had to bring out the big gun, the cannula brush.

Forget Coca Cola, forget hot coffee (I think, really, it's the "hot" part and not the coffee part, that works), forget even the meat tenderizer, when the tube is clogged like this the only thing that really works is going in the tube and fishing the clog out. The first time that Bob's tube clogged like this was back in July (see post July 27th, 2011, Clogged Peg Tube, ER & Hot Coffee) and I freaked out and ended up at the emergency ward with him.

Sometime back around August, the second time it clogged this bad, I knew better than to end up in the ER, I mean, what the heck did they do but try to fish out the clog with every sort of gizmo imaginable and then pour in some hot coffee? I figured I could do that myself. So I brewed up some coffee and went hunting through the house for something to shove down his tube. I tried a bunch of things, including, believe it or not, a coat hanger, which actually got up in the tube but not far enough to unclog it. (Don't worry, I sterilized the stupid thing first.) Nothing was working. Straws were too wide, screw drivers too short. I finally found some picture hanging wire and thought, ah ha! This will work. So I snaked the wire very carefully down the tube and got it through, but when I took it out and tried to flush water through, the tube was still clogged. So I tried it again, but this time, to my horror, the picture wire popped right through the side of the tube. Through the side of the tube. I had put a hole in my husband's peg tube! You can imagine how freaked out I was at this point. Fortunately, the wire had poked a hole near the top of the tube and so, I got out the scissors and snipped off the end. Problem solved, but the tube was still clogged. So I broke down and called the doctor's office for advice.

After a lot of back and forth, I was finally connected with a very nice woman in the GI lab. She told me to come to the hospital and she would leave me a cannula brush at the information desk. A cannula brush is a little Christmas tree shaped bristle brush at the end of a long plastic-coated wire. So I ran to the hospital, picked up not one, but two brushes, talked with GI lab tech who gave me directions and also told me about the meat tenderizer trick. But when I arrived home, the phone was ringing. It was doctor's office, who told me NOT to use the cannula brush, but to bring Bob in immediately. And bring the brush with me. So I had to get Bob dressed, into the wheelchair, into the car, break down the wheelchair, throw that in the trunk, drive to the hospital, repeat the process of getting him out the car and into the doctor's office only to find that the doctor had left for lunch.

So the nurse took my cannula brush and pushed it through Bob's tube and got out the clog. Then she threw the brush away! She threw it away! And told me that the doctor didn't want me inserting the cannula brush because it was too dangerous and I might poke a hole in Bob's tube. I didn't have the courage to tell her that I already poked a hole in his tube that morning with the picture hanging wire. Then she told me if that ever happened, I could always just snip off the end of the tube with a scissors.  Oooh-kay. Didn't have the heart to tell her that one either.

But thank goodness the lab tech had given me two brushes. So I still have one and now I am armed and dangerous.

So back to the present day, I got out the cannula brush and pushed it in, pulled it out, pushed it in, pulled it out. Flushed with hot water, repeat, and the @#&@##! tube is still clogged. This I did repeatedly for thirty minutes to no avail. I'm thinking, crap, I'm going to have to drag Bob down to the doctor's office only to have the nurse steal my cannula brush again and charge us $30.00 to boot. And I don't want to do this. So I keep at it, intermittently praying (please, please unclog this tube) and cursing (god damn it, unclog you @##! tube!) for about 45 minutes, but still the water will not go through. Finally, I took the brush and measured it against Bob's tube (you have to be careful not to enter his stomach with the brush) and I measured it right up to the opening in his stomach then made a mark on the plastic wire with a Sharpie and I snaked that sucker all the way up to the Sharpie mark, and finally, the clog of Jevity poured out.

Well, that was enough excitement for this week. And they say caregiving is a boring job.