A gastrostomy tube (G-tube) is a flexible device inserted through the abdominal wall directly into the stomach to deliver nutrition, fluids, and medication. It is necessary when a person cannot safely swallow or requires supplemental feeding. Flushing the G-tube is a non-negotiable part of its care, maintaining the tube’s patency by keeping the interior passageway open. This routine practice prevents formula or medication residue from accumulating and causing a blockage, which can disrupt the delivery of hydration and nourishment.
Gathering Supplies and Preparation
Gather all necessary supplies in a clean area before starting the procedure. You will need a clean 60-milliliter (mL) enteral feeding syringe and the prescribed volume of water, typically 30 to 60 mL of tap water, saline, or sterile water. Always wash your hands thoroughly with soap and water for at least 20 seconds before touching any part of the tube or supplies to reduce the risk of introducing bacteria. The person receiving the flush should be positioned comfortably with their head and chest elevated to an angle of at least 30 to 45 degrees, which helps prevent reflux and aspiration. Verify the specific flush volume recommended by a medical professional, as this amount is calculated to clear the entire length of the tube.
Step-by-Step G-Tube Flushing
Draw the prescribed volume of water into the syringe, eliminating any air bubbles. If using an extension set, connect it securely to the G-tube feeding port. Connect the syringe filled with water to the external end of the G-tube or the extension set. If the tube has a clamp, open it only after the syringe is securely attached.
Administer the water slowly and steadily by gently pushing the syringe plunger, allowing the fluid to travel the full length of the tube without creating excessive pressure. Alternatively, remove the syringe plunger entirely and allow the water to flow by gravity. If you encounter resistance, stop immediately and do not force the water, as this can cause discomfort or damage the tube.
Once the full volume of water has been administered, clamp the G-tube or extension set before disconnecting the syringe to prevent stomach contents from leaking. The person should remain in the elevated position for at least 30 minutes following the flush to minimize the risk of reflux or aspiration.
Determining the Flushing Schedule
The frequency of G-tube flushing depends on how often the tube is used for feeds and medication, aiming to prevent residue from drying inside the lumen.
Flushing During Use
A flush is required immediately before and after every bolus feeding. Water must also be administered before and after every instance of medication delivery. Use a small volume of water between different medications to prevent them from interacting or forming a precipitate inside the tube.
Routine Flushing
When the tube is not actively being used, a routine scheduled flush is necessary to maintain patency. Healthcare teams typically recommend flushing the tube every four to eight hours throughout the day, even if no feeds or medicines are being given. This washes away any residual stomach contents that may have backed up. For continuous tube feeding, the tube should be flushed at the beginning and end of the session, and often every four hours during the infusion.
Troubleshooting Clogs and Resistance
Resistance when flushing indicates a partial or complete blockage, often caused by formula viscosity or incompletely dissolved medications. If resistance occurs, gently pull back and push the syringe plunger in a slow, pulsating motion using a small amount of warm water. Warm water is more effective at dissolving residue than cold water. Never use excessive force, as this can damage the tube or cause it to rupture.
If pulsating attempts do not clear the obstruction, clamp the tube and allow the water to dwell for 5 to 15 minutes before attempting the push-and-pull motion again. This soaking time helps soften the blockage.
Stop the procedure immediately and contact a healthcare professional if you encounter severe, unyielding resistance, if the person experiences pain, or if you suspect the tube has been pulled out of position. Avoid using household items or unapproved solutions to clear a clog, as this may compromise the tube’s integrity or cause harm.